Comprehensive Diabetic Foot Examination

Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus that had a comprehensive diabetic foot examination with risk categorization based on exam findings during one or more office visits within 12 months

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CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.

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It cannot be overstated that the complications of the diabetic foot are common, complex, and costly, mandating aggressive and proactive preventative assessments by generalists and specialists. All patients with diabetes must have their feet evaluated at least at yearly intervals for the presence of the predisposing factors for ulceration and amputation (neuropathy, vascular disease, and deformities). This quality measure represents a protocol for doing so. If abnormalities are present, more frequent evaluation of the diabetic foot is recommended depending on risk category.(1)

Foot ulceration is the most common single precursor to lower extremity amputations among 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.  Other forms of neuropathy may also play a role in foot ulcerations.  Motor neuropathy resulting in anterior crural muscle atrophy or intrinsic muscle wasting can lead to foot deformities such as foot drop, equinus, and hammertoes.  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.

Recognizing important risk factors and making a logical, treatment-oriented assessment of the diabetic foot requires a consistent and thorough diagnostic approach using a common language.  Without such a method, the practitioner is more likely to overlook vital information and to pay inordinate attention to less critical points in the evaluation.  A useful examination will involve identification of key risk factors and assignment into appropriate risk category.  Only then can an effective treatment plan be designed and implemented. (ACFAS/ACFAOM Clinical Practice Guidelines)

A higher score indicates higher quality

DIABETES CARE, VOLUME 31, NUMBER 8, AUGUST 2008, Boulton, J.M. et al, pp. 1679-85.

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.

TBD

All patients aged18 years and older with a diagnosis of diabetes mellitus with a visit during the measurement period

Equal Initial Population

* Medical reasons
   Includes:
     - not indicated (absence of organ/limb, already received/performed, other)
     - contraindicated (patient allergic history, potential adverse drug interaction, other)

* Patient reasons
   Includes:
     - patient declined
     - economic, social, or religious reasons
     - other patient reasons

* System reasons
   Includes:
     - resources to perform the services not available
     - insurance coverage/payor-related limitations
     - other reasons attributable to health care delivery system

Patients who had a comprehensive diabetic foot exam with risk categorization performed at least once within 12 months

Definition:  A comprehensive diabetic foot examination consists of the following components:
-	General Inspection: Including evaluation of proper footwear
-	Dermatologic: Including skin status, sweating, infection, ulceration, calluses, blistering
-	Musculoskeletal: Including deformity and muscle wasting
-	Neurological Assessment: Including 10 g monofilament and one of the four following: vibration using 128 Hz tuning fork, pinprick sensation, ankle reflexes or vibration perception threshold testing (VPT)
-	Vascular Assessment: foot pulses and ankle brachial pressure
index (ABI) if indicated

Not Applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.