2021 HM4: Functional Status Change for Patients With Upper-limb Functional Status Deficit

Measure Description

Percentage of patients aged 13 years or older with a functional deficit related to the upper-limb who achieve a Minimal Clinically Important Difference (MCID) in QuickDASH or equivalent score that indicates a functional improvement greater than zero. One rate will be reported:

• The Risk-Adjusted MCID proportional difference where the difference between the risk adjusted predicted MCID and the observed MCID (measured via QuickDASH or equivalent tool) proportion is greater than zero.

The measure contains two goals: 1) for patients to achieve an unadjusted MCID greater than zero and, 2) for patients to achieve a risk adjusted MCID where the difference between the risk adjusted predicted MCID and the observed MCID proportion will be greater than zero. The measure is adjusted to patient characteristics known to be associated with functional status and quality of life outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician level, and at the clinic level to assess quality.

Denominator

Denominator Criteria (Eligible cases):

All patients aged 13 years or older with a functional deficit related to the upper-limb functional status on an index visit:
ELBOW
Tendinopathies: M77.0*, M77.1*
OR
Humeroulnar dislocation: S53*
OR
Cubital tunnel syndrome: G56.2*, S54*
OR
Fracture of lower end of humerus: S42.4*
OR
Fracture of ulna: S52.0*, S52.2*, S52.6*
OR
Fracture of radius: S52.3*, S52.5*
OR
+J2 Olecranon bursitis: M70.2*
OR
Other bursitis: M70.3*
OR
Other instability, elbow: M25.32*
OR
Other soft tissue disorders related to use, overuse, and pressure of forearm: M70.83*, M70.84*
OR
Effusion, elbow: M25.42*
OR
Pain in elbow: M25.52*
OR
Stiffness of elbow: M25.62*
OR
Pain in forearm: M79.63*

HAND
Carpal tunnel syndrome: G56.0*
OR
Dislocations: S63.0*, S63.1*, S63.2*
OR
Tendon disorders: S63.3*, S63.4*, S63.5*, S63.6*, S63.8*, S63.9*
OR
Fractures: S62*
OR
Crepitant synovitis: M70.0*
OR
Bursitis of hand: M70.1*
OR
Other soft tissue disorders related to use, overuse and pressure: M70.84*
OR
Other instability, hand: M25.34*
OR
Effusion, hand: M25.44*
OR
Pain in joints of hand: M25.54*
OR
Stiffness of hand: M25.64*
OR
Pain in hand and fingers: M79.64*

WRIST
Other instability, wrist: M25.33*
OR
Effusion, wrist: M25.43
OR
Pain in wrist: M25.53*
OR
Stillness of wrist: M25.63*

SHOULDER
Adhesive capsulitis of the shoulder: M75.0*
OR
Disorder of glenohumeral joint: M94.21*, S43*
OR
Instability: M24.21*, M24.41*, M24.81*, M25.3
OR
Labral pathology: S43.43*
OR
Rotator cuff syndromes: M75.1*
OR
Fracture of clavicle: S42.0*
OR
Fracture of humerus: S42.2*, S42.3*
OR
Other soft tissue disorders related to use, overuse, and pressure of shoulder: M70.81*
OR
Other instability, shoulder: M25.31
OR
Effusion, shoulder: M25.41*
OR
Pain in shoulder: M25.51*
OR
Pain in upper arm: M79.62*
OR
Pain in arm: M79.601, M79.602, M79.603
OR
Stiffness of Shoulder: M25.61*

AND

Denominator Criteria (Eligible Cases):

Submission Criteria 1: Shoulder operative (surgical) patients
Submission Criteria 2: Shoulder (non-surgical) patients
Submission Criteria 3: Elbow operative (surgical) patients
Submission Criteria 4: Elbow (non-surgical) patients
Submission Criteria 5: Wrist and Hand operative (surgical) patients
Submission Criteria 6: Wrist and Hand (non-surgical) patients
Submission Criteria 7: All patients Upper-limb (surgical)
Submission Criteria 8: All patients Upper-limb (non-surgical)
Submission Criteria 9: All patients Upper-limb (surgical and non-surgical)

AND

Two face to face patient encounters for a treatment episode that began or ended during the performance period

Numerator

Percentage of patients aged 13 years or older with a functional deficit related to the upper-limb functional status who achieve a Functional Status Change Residual Score with a Minimal Clinically Important Difference (MCID) to indicate functional improvement greater than zero and a Risk Adjusted Functional Status Change Residual Score for the upper-limb impairment successfully calculated with an MCID score that is greater than zero

Denominator Exclusions

Hospice services received by patient at any time during the performance period
OR
Patient unable to complete a DASH or equivalent assessment tool due to blindness, illiteracy, severe mental incapacity or language incompatibility without the availability of an adequate proxy available

Denominator Exceptions

N/A

Numerator Exclusions

N/A

NQF ID Number

N/A

NQS Domain

Effective Clinical Care

High Priority Measure

Yes

Includes Telehealth?

Yes

Inverse Measure

No

Proportional Measure

Yes

Continuous Variable Measure

No

Ratio Measure

No

Number of performance rates to be calculated and submitted

1

Risk-Adjusted Status?

No