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  • Measure Summary
  • NQMC:004415
  • Sep 2010

Chronic wound care: percentage of patients aged 18 years and older with a diagnosis of diabetes and foot ulcer who were prescribed an appropriate method of offloading (pressure relief) within the 12 month reporting period.

American Society of Plastic Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 35 p. [19 references]

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 18 years and older with a diagnosis of diabetes and foot ulcer who were prescribed an appropriate method of offloading (pressure relief) within the 12 month reporting period.

Rationale

Offloading is a mainstay in the prevention and treatment of diabetic foot ulcers. Despite its importance in the care of patients with diabetic foot ulcers, a recent study examining wound care practices found that approximately 23% of patients with diabetic ulcers had no documentation of offloading devices.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

The reduction of pressure to the diabetic foot ulcer is essential to treatment. Proper off-loading and pressure reduction prevents further trauma and promotes healing. This is particularly important in the diabetic patient with decreased or absent sensation in the lower extremities. (Frykberg et al., American College of Foot and Ankle Surgeons [ACFAS], 2006)

Relieving pressure on the diabetic wound is necessary to maximize healing potential. Acceptable methods of offloading include crutches, walkers, wheelchairs, custom shoes, depth shoes, shoe modifications, custom inserts, custom relief orthotic walkers (CROW), diabetic boots, forefoot and heel relief shoes, and total contact casts. (Wound Healing Society [WHS], 2006)

Removal of pressure from a foot wound (i.e., off-loading) is crucial to the healing process. Many types of devices can offload the infected wound, but it is important to choose one that permits easy inspection. (Lipsky et al., Infectious Diseases Society of America [IDSA], 2004)

Evidence for Rationale

American Society of Plastic Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 35 p. [19 references]

Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV, American College of Foot and Ankle Surgeons. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006 Sep-Oct;45(5 Suppl):S1-66. PubMed External Web Site Policy

Jones KR, Fennie K, Lenihan A. Evidence-based management of chronic wounds. Adv Skin Wound Care. 2007 Nov;20(11):591-600. [42 references] PubMed External Web Site Policy

Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, Lefrock JL, Lew DP, Mader JT, Norden C, Tan JS. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004 Oct 1;39(7):885-910. [290 references] PubMed External Web Site Policy

Steed DL, Attinger C, Colaizzi T, Crossland M, Franz M, Harkless L, Johnson A, Moosa H, Robson M, Serena T, Sheehan P, Veves A, Wiersma-Bryant L. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen. 2006 Nov;14(6):680-92. PubMed External Web Site Policy

Primary Health Components

Chronic wound care; diabetes mellitus; diabetic foot ulcer; offloading/pressure relief devices (crutches, walkers, wheelchairs, custom shoes, depth shoes, shoe modifications, custom inserts, custom relief orthotic walkers [CROW], diabetic boots, forefoot and heel relief shoes, total contact casts)

Denominator Description

All patients aged 18 years and older with a diagnosis of diabetes and foot ulcer (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who were prescribed an appropriate method of offloading (pressure relief) within the 12 month reporting period (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Professional certification

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

The 12 month reporting period

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients aged 18 years and older with a diagnosis of diabetes and foot ulcer

Note: Refer to the original measure documentation for administrative codes.

Exclusions

  • Documentation of medical reason(s) for not prescribing an appropriate method of offloading (pressure relief) (e.g., non-plantar location)
  • Documentation of patient reason(s) for not prescribing an appropriate method of offloading (pressure relief)
  • Documentation of system reason(s) for not prescribing an appropriate method of offloading (pressure relief)

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who were prescribed an appropriate* method of offloading (pressure relief) within the 12 month reporting period

*An appropriate method of offloading (pressure relief) includes any of the following: crutches, walkers, wheelchairs, custom shoes, depth shoes, shoe modifications, custom inserts, custom relief orthotic walkers (CROW), diabetic boots, forefoot and heel relief shoes, or total contact casts.

Note: Refer to the original measure documentation for administrative codes.

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure #6: offloading (pressure relief) of diabetic foot ulcers.

Measure Collection Name

Chronic Wound Care Physician Performance Measurement Set

Submitter

American Society of Plastic Surgeons - Medical Specialty Society

Developer

American Society of Plastic Surgeons - Medical Specialty Society

National Committee for Quality Assurance - Health Care Accreditation Organization

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Scott Endsley, MD, MSc (Co-Chair); William A. Wooden, MD, FACS (Co-Chair); Nicholas Biasotto, DO; Kathleen Lawrence, RN, MSN, CWOCN; Sergey V. Bogdan, MD; Andrew Maurano, PA-C; Stephen K. Bubb, MD; Mark Morasch, MD; H. Gunner Deery, II, MD, FACP, FIDSA; Jessica Pedersen, MBA, OTR/L, ATP; Dirk M. Elston, MD; Michael M. Priebe, MD; Elof Eriksson, MD; Aamir Siddiqui, MD; George Fueredi, MD; Carole (Carrie) Sussman, PT, DPT; Matthew G. Garoufalis, DPM; Amy Wandel, MD, FACS; Sarah Kagan, PhD, RN

American Society of Plastic Surgeons: Melanie Dolak, MHA

American Medical Association: Joseph Gave, MPH; Karen Kmetik, PhD; Shannon Sims, MD, PhD; Samantha Tierney, MPH

National Committee for Quality Assurance: Phil Renner, MBA

PCPI Consultants: Rebecca Kresowik; Timothy Kresowik, MD

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2010 Sep

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

American Society of Plastic Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 35 p. [19 references]

Measure Availability

Source not available electronically.

For more information, contact the American Society of Plastic Surgeons (ASPS) at 444 E. Algonquin Rd., Arlington Heights, IL 60005; Phone: 847-228-9900; Fax: 847-709-7524; Web site: www.plasticsurgery.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 7, 2009. The information was verified by the measure developer on June 4, 2009.

This NQMC summary was retrofitted into the new template on May 13, 2011.

This NQMC summary was edited by ECRI Institute on April 27, 2012.

The information was reaffirmed by the measure developer on January 7, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, contact Diedra D. Gray, Senior Manager, Quality and Health Policy, at the American Society of Plastic Surgeons, 444 E. Algonquin Rd., Arlington Heights, IL 60005; Phone: 847-228-3389.

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