Metrics: Diabetic Foot Infection

How Will You Know You’re Making a Difference?

Diabetic foot infection is not a CMS core measure diagnosis. However, the importance of defining metrics to track in this population is crucial for success. Based on the preliminary work done by the project team, choose metrics that are easy to abstract and conducive to longitudinal study. Use dichotomous variables when possible. Depending on the institution, data for diabetic man­age­ment may already be complied under the scope of PQRI or POA provisions. Take advantage of data already being studied. A sample of metrics for a DFI improvement project might include:

Documentation (yes/no)

• Monofilament testing
• Ulcer staging
• Wound care specialist evaluation
• Diabetic education
• Pedal pulses/ABI

Process (days)

• Time until glycemic control (am BG < 120 mg/dL)
• Time until surgical debridement
• Time until wound culture reported

Outcomes

• Amputation (yes/no)
• Level of amputation (ordinal)
• LOS
• Readmission
• Cost per case

Other

• Order set usage (yes/no)
• Compliance with recommended antibiotics
• Compliance with recommended imaging

1. Part II Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 405, 409, et al. Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009;E-Prescribing Exemption for Computer-Generated Facsimile Transmissions; and Payment for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); Final Rule. Wednesday, November 19, 2008, Book 2 of 2, Pages 69725–70238.
2. Part II Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 411, 412, 413, 422, and 489 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals; Final Rule Tuesday, August 19, 2008, Book 2 of 2, Pages 48433–49084.