![]() CMS uses the electronic medical record (EMR) incentive program to track CQMs, and health care practices receive reimbursement when the appropriate measures are documented. A quality measure is a tool that tracks and measures the value of a health care service and uses data to quantify a provider’s delivery of quality patient care. ![]() In 2014, the Centers for Medicaid and Medicare Services (CMS) included an annual foot exam in primary care as a clinical quality measure (CQM). Foot ulcers and other lower-extremity complications are considered common, multifaceted, and costly and are linked to increased morbidity, loss of quality of life, and mortality, providing further evidence that more frequent comprehensive foot exams are beneficial ( 8).Ī proper foot exam for patients with diabetes should include a thorough history and assessment for risk factors, inspection for any abnormalities, a neurological assessment (i.e., using a 10-g monofilament test to assess pinprick sensation and a tuning fork to determine sensitivity to vibration), and a vascular evaluation of foot pulses ( Table 1). In addition, the ADA’s Standards of Medical Care in Diabetes-2016 recommend an annual comprehensive foot examination to identify risk factors predictive of foot abnormalities, ulcerations, and amputations to decrease morbidity and mortality ( 7). In response to the need for more consistent foot exams, an American Diabetes Association (ADA) task force created the Comprehensive Foot Examination and Risk Assessment. Performing regular foot exams on patients with diabetes in the primary care setting should be a high priority ( 7). Thus, early recognition and proper management of patients at risk for developing foot ulcers and lower-extremity amputations are crucial. In 2012, an Institute for Preventive Foot Health/National Purchase Diary survey revealed that only 46% of patients with diabetes reported ever having foot screenings with their primary care provider ( 6).įoot complications, specifically ulcers and amputations, are the number one reason for hospitalization in patients with diabetes ( 7). However, gaps occur in the care and management of diabetes, especially in the area of foot care. Many of the costs associated with diabetes could be reduced with preventive intervention in the primary care setting, where diabetes is the most common metabolic disorder encountered. The cost of diabetes care in South Carolina is expected to exceed $3 billion in 2016 and to hit $4 billion by 2020 ( 5). In 2013, South Carolina had the fourth highest prevalence of diabetes in the United States, with ∼25,000 diabetes-related hospitalizations and emergency visits, costing $367 million. South Carolina ranks tenth highest in the nation in the percentage of population with diabetes ( 4). Diabetes is a treatable condition, yet it is the seventh leading cause of death in South Carolina.
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