Pain Assessment and Follow-up for Patients with Diabetic Neuropathy (Paired measures)

Measure Purpose: Ensure patients diagnosed with diabetic neuropathy were assessed for pain AND had an appropriate medication offered if the pain assessment identified pain in their feet.

The first numerator: assessment of pain 

is divided by

the denominator: patients diagnosed with diabetic neuropathy.

Pain assessment is defined as a collection of pain in feet score from a 0-10 scale (Numerical Rating Scale (NRS)) or a 0-100 scale (Visual Analog Scale (VAS)) 

Allowable exclusions are removed for:

• Patient declines or refuses to complete pain assessment on date of encounter
• Unable to complete pain assessment on date of encounter

The second numerator: patient offered appropriate pain medication (see measure specifications for appropriate pain medications)

is divided by

the denominator: patients diagnosed with diabetic neuropathy who had identified pain in their feet.

Allowable exclusions are removed for:

• Patient declines or refuses to complete pain assessment on date of encounter
• Unable to complete pain assessment on date of encounter (For example, non-verbal with no care partner present, coma, etc.)
• Patient has contraindications to appropriate pain medications documented in their history
• Patient has an allergy to appropriate pain medications documented in their history
• Patient has previously failed one medication from each class of appropriate pain medications on date of encounter
• Patient has other reason for pain in the feet (For example, plantar fasciitis, osteoarthritis, etc.) in their history

Key Phrases 

Examples of key phrases you could use to meet the measure include:

• NRS is (0-10)
• VAS is (0-100)
• Patient declines to address pain at this visit

Measure Calculation Example

Dr. Tremblay saw 100 patients diagnosed with diabetic neuropathy from January 1 to December 31. This is the denominator for the first component. Six of those patients declined to address pain during their visits. These patients are removed from the denominator. Of the remaining 93 patients, 71 were assessed for pain using the NRS or VAS. This is the numerator for the first component.

Quality of care for the first component = 71/(100-6). Dr. Tremblay has a score of 75.5% for this measure.

Of the 71 patients who reported pain, 51 of them reported their feet as source of pain. This is the denominator for the second component. Of these patients, 32 patients were offered appropriate pain medication. 

Quality of care for the second component = 32/(51). Dr. Tremblay has a score of 62.7% for this measure.