Supplemental Table 1. Quality Measures and Candidate Quality Measures
Source NQS
Domain
Structure, Process, or
Outcome Measure Endorsement/Steward Relevance
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process Review health history to address risk factors for LEND; Blood Glucose levels (HgbA1c,
Fasting, 2 hour post prandial). WOCN General
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process Review health history to address risk factors
for LEND; Renal function: BUN, Creatinine. WOCN General Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for
the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process Review health history to address risk factors
for LEND; CD-4 and HIV viral loads. WOCN General
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process Review health history to address risk factors for LEND; Creactive protein, erythrocyte
sediment rate. WOCN General
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process Review health history to address risk factors
for LEND; Thyroid stimulating hormone. WOCN General
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Outcome
Interventions for Patients With LEND and Ulcers; Maintain dry, stable eschar on noninfected, ischemic,
neuropathic wounds.
WOCN Foot and
Ankle Care Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for
the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process
Interventions for Patients With LEND and Ulcers; Consider use of Vitamin B-12 which may prevent peripheral neuropathic
symptoms.
WOCN General
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process
Interventions for Patients With LEND and Ulcers; Monitory for vitamin D deficiency which has been reported in patients with peripheral neuropathy symptoms.
WOCN General
Crawford, P. E. and M. Fields-Varnado (2013). "Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary." J Wound Ostomy Continence Nurs 40(1): 34-45.
ECC Process
Adjunctive Treatments for Patients with LEND and Ulcers; Refer patients who smoke and have loss of protective sensation to foot care specialists, and include smoking cessation education and counseling.
WOCN General
Lipsky, B. A., et al. (2012). "2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections." Clin Infect Dis 54(12):
e132-173.
ECC Process
Clinicians should select and routinely use a validated classification system, such as that developed by the International Working Group on the Diabetic Foot (IWGDF) (abbreviated with the acronym PEDIS) or IDSA (see below), to classify infections and to help define the mix of types and severity of their cases and their outcomes
IDSA Foot and
Ankle Care
Lipsky, B. A., et al. (2012). "2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections." Clin Infect Dis 54(12):
e132-173.
ECC Process
[Redistribution of pressure off the wound to the entire weight-bearing surface of the foot (“off-loading”).]
While particularly important for plantar wounds, this is also necessary to relieve pressure caused by dressings, footwear, or ambulation to any surface of the wound (strong, high).
IDSA Foot and
Ankle Care
Fox, N., et al. (2012). "Evaluation and management of penetrating lower extremity arterial trauma: An eastern association for the surgery of trauma practice management guideline." Journal of Trauma and Acute Care Surgery 73(5 SUPPL.4): S315-S320.
ECC Process
Computed tomographic angiography (CTA) may be used as the primary diagnostic study for evaluation of penetrating lower extremity vascular injury when imaging is required.
EAST Foot and
Ankle Care
Korean Society for, C., et al. (2014). "Clinical guidelines for the antimicrobial treatment of bone and joint infections in
Korea." Infect Chemother 46(2): 125-138. ECC Process
In cases of acute osteomyelitis, appropriate antimicrobial agents should be given promptly to limit bacteremia, bone necrosis and bone destruction.
KSC, KSID, KOA General
Korean Society for, C., et al. (2014). "Clinical guidelines for the antimicrobial treatment of bone and joint infections in Korea." Infect Chemother 46(2): 125-138.
ECC Process
5. Surgical modalities and duration of antimicrobial agents are determined based on the Cierny-Mader's classification. In general, we recommend antimicrobial treatment of 4–6 weeks after the last major debridement.
However, treatment must be tailored according to the stage and condition of the individual patient.
KSC, KSID, KOA General
Korean Society for, C., et al. (2014). "Clinical guidelines for the antimicrobial treatment of bone and joint infections in
Korea." Infect Chemother 46(2): 125-138. ECC Process
In cases of community-acquired osteomyelitis, nafcillin or cefazolin is recommended as an empirical agent, given that the most commonly isolated organism is methicillin- susceptible S. aureus (MSSA).
KSC, KSID, KOA General
Korean Society for, C., et al. (2014). "Clinical guidelines for the antimicrobial treatment of bone and joint infections in
Korea." Infect Chemother 46(2): 125-138. ECC Process Nafcillin or cefazolin should be administrated
to treat osteomyelitis caused by MSSA. KSC, KSID, KOA General
NQF QPS CCC Process Communication with the physician or other
clinician managing on-going care post fracture
for men and women aged 50 years and older. NQF #0045, NCQA General
NQF QPS CCC Process
Osteoporosis Management in Women Who Had a Fracture
The percentage of women age 50-85 who suffered a fracture and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis in the six months after the fracture.
NQF #0053, NCQA General
CMS PQRS, AHRQ NQMC, NQF QPS ECC Process
Diabetes: Foot Exam: 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.
NQF #0056, PQRS
#163, NCQA Foot and
Ankle Care
AHRQ NQMC, NQF QPS C/PH; P/S Process
Falls: Screening, Risk-Assessment, and Plan of Care to Prevent Future Falls: This is a clinical process measure that assesses falls prevention in older adults. The measure has three rates: A) Screening for Future Fall Risk:
Percentage of patients aged 65 years of age and older who were screened for future fall risk at least once within 12 months; B) Falls:
Risk Assessment: Percentage of patients aged 65 years of age and older with a history of falls who had a risk assessment for falls completed within 12 months; C) Plan of Care for Falls: Percentage of patients aged 65 years of age and older with a history of falls who had a plan of care for falls documented within 12 months.
NQF #0101, NCQA General
AHRQ NQMC, NQF QPS PS Process
Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery
NQF #0218, CMS General
NQF QPS CCC Outcome
Lower-Extremity Amputation among Patients with Diabetes Rate (PQI 16)
Admissions for any-listed diagnosis of diabetes and any-listed procedure of lower- extremity amputation per 100,000 population, ages 18 years and older. Excludes any-listed diagnosis of traumatic lower-extremity amputation admissions, toe amputation admission (likely to be traumatic), obstetric admissions, and transfers from other institutions.
NQF #0285, AHRQ Foot and Ankle Care
CMS PQRS, AHRQ NQMC, NQF QPS
ECC, PCCEO
(2°) Process
Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear: Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing during one or more office visits within 12 month
NQF #0416, PQRS
#127, APMA Foot and
Ankle Care
CMS PQRS, AHRQ NQMC, NQF QPS ECC Process
Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation: Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months
NQF #0417, PQRS
#126, APMA
Foot and Ankle Care
CMS PQRS, AHRQ NQMC, NQF QPS CCC Outcome
Functional status change for patients with foot/ankle impairments: Functional status change in patients aged 18 or older with a foot/ankle impairment associated with a functional deficit that had their functional status assessed at the beginning and end of rehabilitation
NQF #0424, CMS
#219, Focus on Therapeutic Outcomes,
Inc.
Foot and Ankle Care
AHRQ NQMC, NQF QPS PCCEO,
CCC, ECC (2°)
Process
Diabetic Foot Care and Patient Education Implemented: Percentage of home health episodes of care in which diabetic foot care and patient/caregiver education were included in the physician-ordered plan of care and implemented for diabetic patients since the previous OASIS assessment.
NQF #0519, CMS Foot and Ankle Care
AHRQ NQMC PS, CCC
(2°) Process
Diabetic Foot Care and Patient Education in Plan of Care: Percentage of home health episodes of care in which the physician- ordered plan of care includes regular
monitoring for the presence of skin lesions on the lower extremities and patient education on proper diabetic foot care.
CMS Foot and
Ankle Care
AHRQ NQMC CCC,
PCCEO (2°)
Process
Diabetic Foot Care And Patient/Caregiver Education Implemented During Long Term Episodes Of Care: Percentage of long term home health episodes of care during which diabetic foot care and education were included in the physician-ordered plan of care and implemented (since the previous OASIS assessment).
CMS Foot and
Ankle Care
