eMeasure Title

Diabetes: Foot Exam

eMeasure Identifier (Measure Authoring Tool) 123 eMeasure Version number 6.2.000
NQF Number 0056 GUID c0d72444-7c26-4863-9b51-8080f8928a85
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Endorsed By National Quality Forum
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
This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. 

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Measure Scoring Proportion
Measure Type Process
Risk Adjustment
Rate Aggregation
As the seventh leading cause of death in the U.S., diabetes kills approximately 75,000 people a year (CDC FastStats 2015). Diabetes is a group of diseases marked by high blood glucose levels, resulting from the body's inability to produce or use insulin (CDC Statistics 2014, ADA Basics 2013). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC Fact Sheet 2014). 

In 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013).  

Complications due to improper or poor quality of foot care in diabetics can include amputations of the toe, foot, lower and upper leg. Between 1993 and 2009, the CDC monitored the rates of nontraumatic amputations in the diabetic population. Overall, the rates peaked in 1996 with toe amputations at 3.7 per 1,000 diabetic population. Amputations for the foot, lower leg, and upper leg were 1.5, 2.3, and 1.1 per 1,000 diabetic population, respectively, in 1996. Since the late nineties, lower extremity amputation rates in the diabetic population have declined, witnessed by the following rates in 2009: for toe amputations (1.8 per 1,000 diabetic population), followed by lower leg (0.9), foot (0.5) and upper leg (0.4) amputations (CDC, 2012).
Clinical Recommendation Statement
American Diabetes Association (2017) Guidelines/ Recommendations: Perform annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot/leg pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, temperature, ankle reflexes, or vibration perception threshold). (Level of evidence: B)
Improvement Notation
Higher score indicates better quality
American Diabetes Association. Microvascular complications and foot care. Sec. 10. In Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40(Suppl. 1):S88-S98
American Diabetes Association (ADA). 2013. Diabetes Statistics. Retrieved from http://www.diabetes.org/diabetes-basics/diabetes-statistics/.  
Centers for Disease Control and Prevention (CDC). 2012. CDC's Diabetes Program-Data and Trends-Diabetes Surveillance System-Nontraumatic Lower Extremity Amputation with Diabetes by Level of Amputation. Retrieved from http://www.cdc.gov/diabetes/statistics/lealevel/fig8.htm.
Centers for Disease Control and Prevention (CDC). 2014. National Diabetes Statistics Report. http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf
Centers for Disease Control and Prevention (CDC). 2015. FastStats: Deaths and Mortality. www.cdc.gov/nchs/fastats/deaths.htm.
Centers for Disease Control and Prevention. 2014. CDC Features. Diabetes Latest. www.cdc.gov/features/diabetesfactsheet/.
American Diabetes Association. 2013. Diabetes Basics. www.diabetes.org/diabetes-basics/?loc=GlobalNavDB
American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4
1033-46. http://care.diabetesjournals.org/content/36/4/1033.full
Foot exam: visual inspection with a sensory exam and a pulse exam.
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.
Transmission Format
Initial Population
Patients 18-75 years of age with diabetes with a visit during the measurement period
Equals Initial Population
Denominator Exclusions
Patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period. 

Exclude patients who were in hospice care during the measurement year.
Patients who received visual, pulse and sensory foot examinations during the measurement period
Numerator Exclusions
Not Applicable
Denominator Exceptions
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set