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## Complete Summary

#### TITLE

Diabetes mellitus: 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 months.

#### SOURCE(S)

American Podiatric Medical Association (APMA), American College of Foot
and Ankle Surgeons, American College of Foot and Ankle Orthopedics and
Medicine, Centers for Medicare and Medicaid Services. Diabetic foot and
ankle care physician performance measurement set. Bethesda (MD):
American Podiatric Medical Association, Inc.; 2007 Aug. 11 p.

### 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 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
months.

#### 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.

[CLINCAL RECOMMENDATION STATEMENTS]{.underline}:

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. The other common
mechanism of ulceration involves prolonged repetitive moderate stress.
This normally occurs on the sole of the foot and is related to prominent
metatarsal heads, atrophied or anteriorly displaced fat pads, structural
deformity of the lower extremity, and prolonged walking. (American
College of Foot and Ankle Surgeons/American College of Foot and Ankle
Orthopedics and Medicine \[ACFAS/ACFAOM\] Clinical Practice Guidelines)

#### PRIMARY CLINICAL COMPONENT

Diabetes mellitus; foot ulceration prevention; evaluation of proper
footwear

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of diabetes
mellitus (see the related \"Denominator Inclusions/Exclusions\" field in
the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who were evaluated for proper footwear and sizing at least once
within 12 months (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

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### 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\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians\
Podiatrists

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

See the \"Rationale\" field.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

See the \"Rationale\" field.

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients aged 18 years and older with a diagnosis of diabetes mellitus

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with a diagnosis of diabetes
mellitus

**Note**: An International Classification of Diseases, Ninth Revision
(ICD-9) diagnosis code to identify patients with a diagnosis of diabetes
mellitus and a Current Procedural Terminology Evaluation and Management
(CPT E/M) service code or a CPT procedure code are required for
denominator inclusion. Refer to the original measure documentation for
coding details.

**Exclusions**\
Documented medical, patient or system reasons for exclusion. Refer to
the original measure documentation for coding details.

#### 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 is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who were evaluated\* for proper footwear and sizing at least
once within 12 months

Refer to original measure documentation for coding details.

\*Evaluation for proper footwear includes a foot examination documenting
the vascular, neurological, dermatological and structural/biomechanical
findings. The foot should be measured using a standard measuring device
and counseling on appropriate footwear should be based on risk
categorization.

**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 higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #POD 3: diabetic foot & ankle care, ulcer prevention -
evaluation of footwear.

#### MEASURE COLLECTION

[Diabetic Foot and Ankle Care Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2061&doc=12946)

#### DEVELOPER

American Podiatric Medical Association

#### FUNDING SOURCE(S)

American Podiatric Medical Association

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Clinical Practice Advisory Committee of American Podiatric Medical
Association (APMA) in conjunction with the American College of Foot and
Ankle Surgeons (ACFAS) and the American College of Foot and Ankle
Orthopedics and Medicine (ACFAOM) representing podiatric physicians from
researchers, to teachers to practicing podiatrists

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

There were no potential conflicts of interest to report in the
development of these measures.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Aug

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Podiatric Medical Association (APMA), American College of Foot
and Ankle Surgeons, American College of Foot and Ankle Orthopedics and
Medicine, Centers for Medicare and Medicaid Services. Diabetic foot and
ankle care physician performance measurement set. Bethesda (MD):
American Podiatric Medical Association, Inc.; 2007 Aug. 11 p.

#### MEASURE AVAILABILITY

The individual measure, \"Measure #POD 3: Diabetic Foot & Ankle Care,
Ulcer Prevention - Evaluation of Footwear,\" is published in the
\"Diabetic Foot and Ankle Care Physician Performance Measurement Set.\"

For more information, contact: American Podiatric Medical Association,
9312 Old Georgetown Road, Bethesda, MD 20814-1621; Phone: (301)
581-9200; Web site:
[www.apma.org](http://www.apma.org/s_apma/index.asp).

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on October 3, 2008.
The information was verified by the measure developer on November 12,
2008.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 12/22/2008