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## Complete Summary

#### TITLE

Diagnosis and treatment of adult degenerative joint disease
(DJD)/Osteoarthritis (OA) of the knee: percentage of patients diagnosed
with DJD with knee x-ray panels that include a standing view of the
knee.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Diagnosis and
treatment of adult degenerative joint disease (DJD)/osteoarthritis (OA)
of the knee. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2007 Mar. 41 p. \[54 references\]

### 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 diagnosed with
degenerative joint disease (DJD) with knee x-ray panels that include a
standing view of the knee.

#### RATIONALE

The priority aim addressed by this measure is to improve the efficacy of
diagnostic imaging for evaluating degenerative joint disease (DJD).

#### PRIMARY CLINICAL COMPONENT

Degenerative joint disease (DJD); knee; diagnostic imaging; x-ray
(standing view)

#### DENOMINATOR DESCRIPTION

Total number of patients with a diagnosis specific for degenerative
joint disease (DJD) in the knee who have any knee x-ray panel taken (see
the related \"Denominator Inclusions/Exclusions\" field in the Complete
Summary)

#### NUMERATOR DESCRIPTION

Number of patients with degenerative joint disease (DJD) with a knee
x-ray panel that includes a standing view (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

-   [Diagnosis and treatment of adult degenerative joint disease
    (DJD)/osteoarthritis (OA) of the
    knee.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=11081)

### 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 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

The American College of Rheumatology reports that more than 21 million
Americans are affected by osteoarthritis. It is the most common type of
arthritis, which is the leading cause of disability in the United
States. The Centers for Disease Control and Prevention (CDC) estimates
that by the year 2020, sixty million Americans, or almost 20% of the
population, will be affected by some form of arthritis, and nearly 12
million will experience activity limitation.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Institute for Clinical Systems Improvement (ICSI). Diagnosis and
treatment of adult degenerative joint disease (DJD)/osteoarthritis (OA)
of the knee. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2007 Mar. 41 p. \[54 references\]

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

See the \"Incidence/Prevalence\" field.

#### UTILIZATION

Unspecified

#### COSTS

Total costs associated with arthritis are estimated by the Centers for
Disease Control and Prevention (CDC) to be almost \$65 billion annually.

#### EVIDENCE FOR COSTS

Institute for Clinical Systems Improvement (ICSI). Diagnosis and
treatment of adult degenerative joint disease (DJD)/osteoarthritis (OA)
of the knee. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2007 Mar. 41 p. \[54 references\]

### 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

All patients age 18 and older with a diagnosis of degenerative joint
disease (DJD)

The medical records of a random sample of patients who have a
degenerative joint disease diagnosis specific to the knee may be
reviewed monthly. From the claims (billing) data, all patients age 18
and older with degenerative joint disease of the knee may be identified.
If possible, this list might be reduced to include only those who had
knee x-rays at that visit. This patient pool may then be used to
randomly select cases for review of the x-ray panels taken and
determination of which of those panels included a standing view x-ray.
Alternatively, the Degenerative Joint Disease Optional Data Collection
Tool (provided as an example at the end of the measurement section of
the original guideline \[refer to the National Guideline Clearinghouse
(NGC) summary of the Institute for Clinical Systems Improvement (ICSI)
guideline [Diagnosis and Treatment of Adult Degenerative Joint Disease
(DJD)/Osteoarthritis (OA) of the
Knee](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=11081&string=5844)\])
could be used for data collection as patients present with a painful
knee.

Data may be collected monthly.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of patients with a diagnosis specific for degenerative
joint disease (DJD) in the knee\* who have any knee x-ray panel taken

\*Degenerative joint disease of the knee might be identified using the
following International Classification of Diseases, Ninth Revision
(ICD-9) codes:

-   715.96 - Osteoarthritis (degenerative) of the lower leg

-   715.16 - Osteoarthritis (degenerative) idiopathic, primary, lower
    leg

-   715.26 - Osteoarthritis (degenerative) secondary, lower leg

-   715.36 - Osteoarthritis (degenerative) localized, lower leg

**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\
Diagnostic Evaluation\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients diagnosed with degenerative joint disease with a knee
x-ray panel that includes a standing view\*

\*X-ray panels that include a standing view might be identified by the
following Current Procedure Terminology (CPT) codes:

-   73562 - Includes anteroposterior, lateral and/or patellar views
    (this code is used as a 3 view code, i.e., code 73560 **plus** a
    standing view)

-   73565 - Radiologic examination, both knees, standing,
    anteroposterior

**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

Percentage of patients diagnosed with degenerative joint disease with
knee x-ray panels that include a standing view of the knee.

#### MEASURE COLLECTION

[Diagnosis and Treatment of Adult Degenerative Joint Disease (DJD) of
the Knee
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=4434)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2003 Nov

#### REVISION DATE

2007 Mar

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Diagnosis and treatment of adult degenerative joint
disease (DJD) of the knee. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2004 Nov. 43 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Diagnosis and
treatment of adult degenerative joint disease (DJD)/osteoarthritis (OA)
of the knee. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2007 Mar. 41 p. \[54 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients diagnosed with
degenerative joint disease with knee x-ray panels that include a
standing view of the knee,\" is published in \"Health Care Guideline:
Diagnosis and Treatment of Adult Degenerative Joint Disease
(DJD)/Osteoarthritis (OA) of the Knee.\" 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 July 19, 2004. This summary
was updated by ECRI Institute on January 13, 2005 and again on September
25, 2007.

#### 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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adaptations or revisions or modifications made to the abstracts of the
ICSI Measures.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008