chart-review-crc-nccn-adherence

name	chart-review-crc-nccn-adherence
description	Colorectal cancer (CRC) NCCN guideline-concordance review. Activate when assessing whether a CRC patient's care adhered to NCCN — molecular (MSI/MMR) testing, staging workup, adequate lymph-node harvest, and stage-appropriate adjuvant chemo / neoadjuvant chemoradiation — answering concordance questions per patient from pathology, radiology, oncology, and operative notes plus structured EHR data.

CRC chart review — STORE abstraction + NCCN concordance

For each in-scope CRC patient you answer the questions in references/questions/, in two tiers: confirm eligibility, then abstract the STORE 2025 data elements (the core chart-review questions). The NCCN concordance verdicts are then computed deterministically by the rule-engine from those facts (references/rules/concordance.yaml) — you do not judge concordance directly.

Procedure

1. Eligibility + context (eligibility.yaml, T0): confirm this is a CRC case, the subsite (colon vs. rectal), and the AJCC stage group. Answer first — these gate scope and set the N/A (Excluded) conditions for the stage-conditional rules.
2. Abstraction (abstraction.yaml, T1) — the core chart-review questions: abstract the STORE 2025 data elements (primary site, histology, grade, TNM, LVI, node counts, margins, MSI/MMR, surgery, chemo, radiation) plus the baseline staging facts (cross-sectional imaging, baseline CEA). Answer verbatim where possible — these facts feed the concordance rules, so accuracy here drives the verdicts.
3. Concordance is automatic. The rule-engine evaluates the five NCCN rules in references/rules/concordance.yaml over your eligibility + abstraction answers — each resolves to Concordant / Non-concordant / Excluded (N/A), and a non-concordant verdict gets an attribution category (references/attribution.yaml). You do NOT answer these; if a verdict looks wrong, correct the underlying abstracted fact.
4. Cite evidence for every abstraction answer: a verbatim note quote (path / radiology / oncology / operative), or a structured row (labs/orders) when that is the source. Do not infer from parametric knowledge.

Scope (from the CRC EvoSkill design)

• Abstraction (Section 2, Domains 1–4): ~18 STORE data elements across cancer identification, staging (TNM), surgical/pathologic features, first-course treatment, and baseline staging workup — the primary chart-review questions (the only thing the agent answers).
• Concordance (Section 3): five NCCN rules computed by the rule-engine — MSI/MMR testing, staging-workup completeness, ≥12-node harvest, Stage III adjuvant chemo, locally-advanced rectal neoadjuvant chemoradiation.

Intentionally out of scope: the study's baselines / Base+Human-Skills / EvoSkill conditions, difficulty levels, data-prep/linkage, train-val-test, and evaluation metrics — this package is the task rubric only.