eMeasure Title

Diabetes: Foot Exam

eMeasure Identifier (Measure Authoring Tool) 123 eMeasure Version number 5.0.000
NQF Number 0056 GUID c0d72444-7c26-4863-9b51-8080f8928a85
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Endorsed By National Quality Forum
Description
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
Copyright
Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

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Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 World Health Organization. All Rights  Reserved.
Disclaimer
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
 
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Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
As the seventh leading cause of death in the U.S., diabetes kills approximately 75,000 people a year (CDC FastStats 2015). Diabetes is a group of diseases marked by high blood glucose levels, resulting from the body's inability to produce or use insulin (CDC Statistics 2014, ADA Basics 2013). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC Fact Sheet 2014). 

In 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013).  

Complications due to improper or poor quality of foot care in diabetics can include amputations of the toe, foot, lower and upper leg. Between 1993 and 2009, the CDC monitored the rates of nontraumatic amputations in the diabetic population. Overall, the rates peaked in 1996 with toe amputations at 3.7 per 1,000 diabetic population. Amputations for the foot, lower leg, and upper leg were 1.5, 2.3, and 1.1 per 1,000 diabetic population, respectively, in 1996. Since the late nineties, lower extremity amputation rates in the diabetic population have declined, witnessed by the following rates in 2009: for toe amputations (1.8 per 1,000 diabetic population), followed by lower leg (0.9), foot (0.5) and upper leg (0.4) amputations (CDC, 2012).
Clinical Recommendation Statement
American Diabetes Association (2015) Guidelines/ Recommendations: Perform annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold).
Improvement Notation
Higher score indicates better quality
Reference
American Diabetes Association. Microvascular complications and foot care. Sec. 9. In Standards of Medical Care in Diabetesd2015. Diabetes Care 2015;38(Suppl. 1):S58-S66
Reference
American Diabetes Association (ADA). 2013. Diabetes Statistics. Retrieved from http://www.diabetes.org/diabetes-basics/diabetes-statistics/.  
Reference
Centers for Disease Control and Prevention (CDC). 2012. CDC's Diabetes Program-Data and Trends-Diabetes Surveillance System-Nontraumatic Lower Extremity Amputation with Diabetes by Level of Amputation. Retrieved from http://www.cdc.gov/diabetes/statistics/lealevel/fig8.htm.
Reference
Centers for Disease Control and Prevention (CDC). 2014. National Diabetes Statistics Report. http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf
Reference
Centers for Disease Control and Prevention (CDC). 2015. FastStats: Deaths and Mortality. www.cdc.gov/nchs/fastats/deaths.htm.
Reference
Centers for Disease Control and Prevention. 2014. CDC Features. Diabetes Latest. www.cdc.gov/features/diabetesfactsheet/.
Reference
American Diabetes Association. 2013. Diabetes Basics. www.diabetes.org/diabetes-basics/?loc=GlobalNavDB
Reference
American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4
1033-46. http://care.diabetesjournals.org/content/36/4/1033.full
Definition
Foot exam: visual inspection with either a sensory exam or a pulse exam
Guidance
Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included
Transmission Format
TBD
Initial Population
Patients 18-75 years of age with diabetes with a visit during the measurement period
Denominator
Equals Initial Population
Denominator Exclusions
Patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period
Numerator
Patients who received visual, pulse and sensory foot examinations during the measurement period
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None