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  • Measure Summary
  • NQMC:004414
  • Sep 2010

Chronic wound care: percentage of patients aged 18 years and older with a diagnosis of venous ulcer who received education regarding the need for long term compression therapy including interval replacement of compression stockings 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 venous ulcer who received education regarding the need for long term compression therapy including interval replacement of compression stockings within the 12 month reporting period.

Rationale

Venous ulcers often recur, especially in patients who are not compliant with compression therapy, with rates as high as 70%. "Numerous investigators have found that compliance is dependent on patient access to compression stockings and appropriate education." As a result, long term maintenance including the continued appropriate use of compression therapy must be addressed through patient education.

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

Part of any prevention program must be patient education. This education should include the patient's individual skin care program, moisturizers, soaps and protective measures. The patient should be educated about the long term nature of this medical condition and the signs and symptoms of recurrence. There are many therapeutic modalities that have been shown to reduce the recurrence of lower extremity wounds includ[ing] graduated compression stockings (GCS) for patients with venous hypertension or at risk for venous insufficiency disease. (American Society of Plastic Surgeons [ASPS], 2007)

Patients with healed or surgically repaired venous ulcers should use compression stockings constantly and forever. (Wound Healing Society [WHS], 2006)

Compression stockings or other compression devices must be worn for the prevention of venous edema and venous leg ulcer recurrence. It is recommended that patients understand that compression therapy is needed for the rest of their lives [including the need to] apply compression stockings upon first rising in the morning, replace stockings regularly—about every 3 months—to provide optimal compression, have someone correctly measure stockings, which should include ankle circumference, length of leg from foot to knee, and midcalf circumference. These measurements should be done in the morning before edema occurs. Knee-length stockings are generally recommended. (Wound, Ostomy, and Continence Nurses Society [WOCN], 2005)

Compression, elevation, ambulation post healing [are recommended] to prevent recurrence. (Association for the Advancement of Wound Care [AAWC], 2005)

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]

American Society of Plastic Surgeons. Evidence-based clinical practice guideline: chronic wounds of the lower extremity. Arlington Heights (IL): American Society of Plastic Surgeons; 2007 May. 21 p. [132 references]

Association for the Advancement of Wound Care (AAWC). Summary algorithm for venous ulcer care with annotations of available evidence. Malvern (PA): Association for the Advancement of Wound Care (AAWC); 2005. 25 p. [147 references]

Korn P, Patel ST, Heller JA, Deitch JS, Krishnasastry KV, Bush HL, Kent KC. Why insurers should reimburse for compression stockings in patients with chronic venous stasis. J Vasc Surg. 2002 May;35(5):950-7. PubMed External Web Site Policy

Robson MC, Cooper DM, Aslam R, Gould LJ, Harding KG, Margolis DJ, Ochs DE, Serena TE, Snyder RJ, Steed DL, Thomas DR, Wiersma-Bryant L. Guidelines for the treatment of venous ulcers. Wound Repair Regen. 2006 Nov-Dec;14(6):649-62. PubMed External Web Site Policy

Wound, Ostomy, and Continence Nurses Society (WOCN). Guideline for management of wounds in patients with lower-extremity venous disease. Glenview (IL): Wound, Ostomy, and Continence Nurses Society (WOCN); 2005. 42 p. (WOCN clinical practice guideline; no. 4).  [86 references]

Primary Health Components

Chronic wound care; venous ulcer; patient education; long term compression therapy; interval replacement of compression stockings

Denominator Description

All patients aged 18 years and older with a diagnosis of venous ulcer

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

Numerator Description

Patients who received education regarding the need for long term compression therapy including interval replacement of compression stockings within the 12 month reporting period

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

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

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

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 venous ulcer

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

Exclusions
None

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Patients who received education regarding the need for long term compression therapy including interval replacement of compression stockings within the 12 month reporting period

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 #5: patient education regarding long term compression therapy.

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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