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## Complete Summary

#### TITLE

Ankle sprain: percentage of patients with acute ankle sprain receiving
ankle x-rays at clinic within 3 days of the initial injury.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Ankle sprain.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2006 Mar. 26 p. \[24 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients with acute
ankle sprain receiving ankle x-rays at clinic within 3 days of the
initial injury.

#### RATIONALE

The priority aim addressed by this measure is to improve the appropriate
use of diagnostic imaging for patients presenting with acute ankle
sprain injuries.

#### PRIMARY CLINICAL COMPONENT

Ankle sprain; x-ray

#### DENOMINATOR DESCRIPTION

Total number of patients with acute ankle sprain 5 years and older seen
within 3 days of the initial injury (patient has not been seen in the
clinic with a diagnosis of ankle sprain within the past 6 months) (see
the related \"Denominator Inclusions/Exclusions\" field in the Complete
Summary)

#### NUMERATOR DESCRIPTION

Number of patients with acute ankle sprain in the denominator receiving
ankle x-rays (see the related \"Numerator Inclusions/Exclusions\" field
in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Ankle
    sprain.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=8948)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 5 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients age 5 years and older presenting with acute lateral ankle pain
caused by inversion of the ankle

Medical groups should identify acute ankle injury patients seen at the
clinic. Inversion injuries is defined operationally as turning ankle
\"in\" and \"under\" or \"twisting.\" These injuries most frequently
occur during walking, running, or during participation in sporting
activities. The definition of the sprain could also include one of the
three lateral ligaments of the ankle (fibulocalcaneal, talofibular, or
anterior talofibular). Each medical group will need to identify which
terms their physicians use to describe inversion sprains. The medical
group can then generate a list of all eligible acute ankle sprain
patients seen during the target month. A random sample of 10 charts can
be chosen from the list. The eligible patients are those who are 5 years
and older and have not been in the clinic with an ankle sprain within
the previous 6 months. The patient\'s medical records will be reviewed
to determine if the patient received an x-ray within 3 days of the
initial injury. Ankle x-rays would include Anterior-Posterior (AP),
Lateral, and/or Mortis views.

A minimum of 10 charts per month should be reviewed. Data can be
collected monthly.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of patients with acute ankle sprain\* 5 years and older
seen within 3 days of the initial injury

\*Patients with a diagnosis code of V72.5, 719.47, 729.5, 845, 845.0,
845.00, 845.02, 845.03, 845.10, or 848.9 who have not been seen in
clinic with the same diagnosis codes within the previous 6 months.

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients with acute ankle sprain in the denominator receiving
ankle x-rays\*

\*Patients with a diagnosis code of V72.5, 719.47, 729.5, 845, 845.0,
845.00, 845.02, 845.03, 845.10, or 848.9 and having an ankle x-ray
(Current Procedure Terminology \[CPT-4\] codes 73600 or 73610).

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a lower score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

#### PRESCRIPTIVE STANDARD

The target goal for this measure is towards 0%.

#### EVIDENCE FOR PRESCRIPTIVE STANDARD

Institute for Clinical Systems Improvement (ICSI). Ankle sprain.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2006 Mar. 26 p. \[24 references\]

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of patients with acute ankle sprain receiving ankle x-rays at
clinic within 3 days of the initial injury.

#### MEASURE COLLECTION

[Ankle Sprain
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=4457)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2003 Jul

#### REVISION DATE

2006 Mar

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Ankle Sprain. Bloomington (MN): Institute for
Clinical Systems Improvement (ICSI); 2003 Jul. 26 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Ankle sprain.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2006 Mar. 26 p. \[24 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients with acute ankle sprain
receiving ankle x-rays at clinic within 3 days of the initial injury,\"
is published in \"Health Care Guideline: Ankle Sprain.\" This document
is available from the [Institute for Clinical Systems Improvement (ICSI)
Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on May 11, 2004. This NQMC
summary was updated by ECRI on May 1, 2006.

#### COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement
\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008