Functional Status Assessment for Knee Replacement

Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed  baseline and follow-up (patient-reported) functional status assessments.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.  NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Measuring functional status for patient undergoing total knee replacement permits longitudinal assessment - from the patient’s perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock 2010).

Clinicians should ask patients to report on functional status during at least two points in time while undergoing treatment: before surgery and after a period of post-surgical recovery.

A higher score indicates better quality

Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG et al.  A comparison of outcomes in osteoarthritis patient undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage, 9 (2001), pp. 137-146.

Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidauretta I.  Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoathritis Cartilage, 15 (2007), pp.273-280.

Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.

Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.

Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG.  Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans.  Health Services Research 2010; 45(2): 376-396.

A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity.

The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.

Adults aged 18 and older who had a primary total knee arthroplasty (TKA) within the 12 month period that begins 180 days before the start of the measurement period and ends 185 days after the start of the measurement period and who had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after TKA procedure.

Equals initial patient population

Patients with multiple traumas at the time of the total knee arthroplasty or patients with severe cognitive impairment

Patients with patient reported functional status assessment results (e.g., VR-12, VR-36, PROMIS-10 Global Health, PROMIS-29, KOOS) not more than 180 days prior to the primary TKA procedure, and at least 60 days and not more than 180 days after TKA procedure

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

Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
- AND:
  - OR: "Occurrence A of Procedure, Performed: Primary TKA Procedure" <= 180 day(s) ends before start of "Measurement Period"
  - OR: "Occurrence A of Procedure, Performed: Primary TKA Procedure" <= 185 day(s) ends after start of "Measurement Period"
  - OR: "Occurrence A of Procedure, Performed: Primary TKA Procedure" ends concurrent with "Measurement Start Date"
- AND:
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Outpatient Consultation" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Encounter, Performed: Outpatient Consultation" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Encounter, Performed: Outpatient Consultation" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Office Visit" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Encounter, Performed: Office Visit" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Fracture - Lower Body" < 1 day(s) starts before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence A of Diagnosis, Active: Fracture - Lower Body" >= 1 hour(s) ends after start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Diagnosis, Active: Fracture - Lower Body" < 1 day(s) starts before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
    - AND: "Occurrence B of Diagnosis, Active: Fracture - Lower Body" >= 1 hour(s) ends after start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Severe Dementia" starts before or during "Measurement Period"
    - AND NOT: "Occurrence A of Diagnosis, Active: Severe Dementia" ends before start of "Measurement Period"
Numerator =
- AND: "Occurrence A of Functional Status, Result: Functional Status Assessment for Knee Replacement" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
- AND: "Occurrence B of Functional Status, Result: Functional Status Assessment for Knee Replacement" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
- AND: "Occurrence B of Functional Status, Result: Functional Status Assessment for Knee Replacement" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
Denominator Exceptions =
- None

"Diagnosis, Active: Fracture - Lower Body" using "Fracture - Lower Body Grouping Value Set (2.16.840.1.113883.3.464.1003.113.12.1037)"
"Diagnosis, Active: Severe Dementia" using "Severe Dementia Grouping Value Set (2.16.840.1.113883.3.526.3.1025)"
"Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1048)"
"Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1008)"
"Functional Status, Result: Functional Status Assessment for Knee Replacement" using "Functional Status Assessment for Knee Replacement Grouping Value Set (2.16.840.1.113883.3.464.1003.118.12.1030)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
"Procedure, Performed: Primary TKA Procedure" using "Primary TKA Procedure Grouping Value Set (2.16.840.1.113883.3.464.1003.198.12.1007)"

"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"

eMeasure Title	Functional Status Assessment for Knee Replacement
eMeasure Identifier (Measure Authoring Tool)	66	eMeasure Version number	3
NQF Number	Not Applicable	GUID	be8d9655-1194-46ef-b43e-4b1d0c36ab71
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	Centers for Medicare & Medicaid Services
Measure Developer	National Committee for Quality Assurance
Endorsed By	None
Description	Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments.
Copyright	Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.
Disclaimer	These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Measuring functional status for patient undergoing total knee replacement permits longitudinal assessment - from the patient’s perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock 2010).
Clinical Recommendation Statement	Clinicians should ask patients to report on functional status during at least two points in time while undergoing treatment: before surgery and after a period of post-surgical recovery.
Improvement Notation	A higher score indicates better quality
Reference	Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG et al. A comparison of outcomes in osteoarthritis patient undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage, 9 (2001), pp. 137-146.
Reference	Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidauretta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoathritis Cartilage, 15 (2007), pp.273-280.
Reference	Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.
Reference	Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.
Reference	Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG. Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. Health Services Research 2010; 45(2): 376-396.
Definition	None
Guidance	A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.
Transmission Format	TBD
Initial Patient Population	Adults aged 18 and older who had a primary total knee arthroplasty (TKA) within the 12 month period that begins 180 days before the start of the measurement period and ends 185 days after the start of the measurement period and who had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after TKA procedure.
Denominator	Equals initial patient population
Denominator Exclusions	Patients with multiple traumas at the time of the total knee arthroplasty or patients with severe cognitive impairment
Numerator	Patients with patient reported functional status assessment results (e.g., VR-12, VR-36, PROMIS-10 Global Health, PROMIS-29, KOOS) not more than 180 days prior to the primary TKA procedure, and at least 60 days and not more than 180 days after TKA procedure
Numerator Exclusions	Not applicable
Denominator Exceptions	None
Measure Population	Not Applicable
Measure Observations	Not Applicable
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 Data Elements)

Reporting Stratification

Supplemental Data Elements