Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear (NQF 0416)

eMeasure Name Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear eMeasure Id 199A49BF-4B2D-4AFE-B917-768FA6FFB69D
Version number 1 eMeasure Set Id B58D69C2-8B86-4E95-9D7C-4FBCF6D48015
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Podiatric Medical Association
Endorsed by National Quality Forum
Description Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Foot ulceration is the most common single precursor to lower extremity amputations among persons with diabetes. Shoe trauma, in concert with loss of protective sensation and concomitant foot deformity, is the leading event precipitating foot ulceration in persons with diabetes. Treatment of infected foot wounds accounts for up to one-quarter of all inpatient hospital admissions for people with diabetes in the United States. Peripheral sensory neuropathy in the absence of perceived trauma is the primary factor leading to diabetic foot ulcerations. Approximately 45-60% of all diabetic ulcerations are purely neuropathic. In people with diabetes, 22.8% have foot problems - such as amputations and numbness – compared with 10% of nondiabetics. Over the
age of 40 years old, 30% of people with diabetes have loss of sensation in their feet.
Clinical Recommendation Statement
The multifactorial etiology of diabetic foot ulcers is evidenced by the numerous pathophysiologic pathways that can potentially lead to this disorder. Among these are two common mechanisms by which foot deformity and neuropathy may induce skin breakdown in persons with diabetes. The first mechanism of injury refers to prolonged low pressure over a bony prominence (i.e., bunion or hammertoe deformity). This generally causes wounds over the medial, lateral, and dorsal aspects of the forefoot and is associated with tight or ill-fitting shoes. (ACFAS/ACFAOM Clinical Practice Guidelines)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Int J Clin Pract. 2007 Nov;61 (11): 1900-4
Reference
J Am Podiatr Med Assoc. 2006 Jul-Aug;96 (4): 290-2
Definition
Initial Patient Population(s): All patients age 18 years or older.
Definition
Denominator(s): All patients age 18 years or older with a diagnosis of diabetes mellitus.
Definition
Denominator Exclusion(s): Bilateral foot amputee
Definition
Numerator(s): The number of patients age 18 years or older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing at least once within 12 months.
Definition
Denominator Exception(s): N/A
Guidance
A diabetic foot exam includes vascular, neurological, dermatological, and structural/biomechanical findings. The foot should be measured using a standard measuring device, and counseling should be based on risk categorization (see list below). The exam should be performed on each of the patient's feet, if present.

Risk Classification Based on the Comprehensive Foot Exam
- Risk Category 0. No LOPS, no PAD, no deformity
  Treatment Recommendations: Patient education including advice on appropriate footwear
  Suggested Follow-up: Annually (by generalist and/or specialist)
- Risk Category 1. LOPS +/- deformity
  Treatement Recommendation: (i.) Consider prescriptive or accommodative footwear 
  (ii.) Consider prophylactic surgery if deformity is not able to be safely accommodated in shoes. Continue patient education
  Suggested Follow-up: Every 3-6 months (by generalist or specialist)
- Risk Category 2. PAD +/- LOPS
  Treatement Recommendation: (i.) Consider prescriptive or accommodative footwear 
  (ii.) Consider vascular consultation for combined follow-up
  Suggested Follow-up: Every 2-3 months (by specialist)
- Risk Category 3. History of ulcer or amputation
  Treatement Recommendation: (i.) Same as Category 1; 
  (ii.) Consider vascular consultation for combined follow-up if PAD present
  Suggested Follow-up: Every 1-2 months (by specialist)
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012