eMeasure Title

CDR 5: Adequate Compression at each visit for Patients with Venous Leg Ulcers

eMeasure Identifier (Measure Authoring Tool) 452 eMeasure Version number 0.0.008
NQF Number None GUID 05677595-dc96-4763-999c-8bcaeaa684ed
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward US Wound Registry
Measure Developer US Wound Registry
Endorsed By None
Description
Percentage of patients aged 18 years and older with a diagnosis of venous leg ulcers (VLU) who received adequate compression at each visit within the 12-month reporting period.
Copyright
None
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Adult Outpatient Visit
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Compression increases ulcer healing rates compared with no compression. Multi-component systems are more effective than single-component systems. Multi-component systems containing an elastic bandage appear more effective than those composed mainly of inelastic constituents. The Definition of Adequate Compression is a system which applies 30-40mmHg at the ankle; a multilayer high-compression device, which includes 3- or 4-layer short stretch bandages; and/or paste-containing bandages (e.g., Duke or Unna’s boot). Compression stockings may be helpful in preventing ulcer recurrence but are a less ideal option for pressure ulcer treatment. The level of compression (pressure applied) will need to be modified if the patient has significant arterial occlusive disease.

Principle: Venous hypertension causes lower leg edema and in more severe cases, venous ulcers. Compression of the affected area helps remove the leg edema, which in turn permits healing of the ulcer.

Relationship of Process to Outcome:
RCTs demonstrate that VLU healing is related to the consistent application of adequate compression during periods of ambulation. 

Gap in Practice:
USWR studies show that patients with venous ulcers are put in adequate compression in fewer than 17% of visits even at hospital based outpatient wound centers. However, when the data from the recently retired PQRS measure is reviewed which allowed clinicians to pass the measure by applying ANY compression (adequate not defined) ONCE in a 12 month period, all eligible providers passed the measure. The USWR tested a measure of adequate compression at each visit across the registry data set and found the pass rate would have been below 10%.
Clinical Recommendation Statement
 
Improvement Notation
Higher score indicates higher quality.
Reference
"Venous ulcer healing is increased when adequate compression is applied to the lower extremity. Venous ulceration results from an elevated ambulatory venous pressure (venous hypertension). This frequently causes edema of the limb. External compression has been the mainstay to combat these problems. The use of a Class 3 (most supportive) high-compression system (three layer, four layer, short stretch, paste-containing bandages, e.g., Unna's boot, Duke boot) is indicated in the treatment of venous ulcers. Although these modalities are similar in effectiveness, they can differ significantly in comfort and cost. The degree of compression must be modified when mixed venous/arterial disease is confirmed during the diagnostic work-up (Level I evidence)."
Reference
Compression for venous leg ulcers. O'Meara S, Cullum NA, Nelson EA. Department of Health Sciences, University of York, Area 3 Seebohm Rowntree Building, Heslington, York, UK, YO10 5DD. smo4@york.ac.uk Update in Cochrane Database Syst Rev. 2012;11:CD000265.  there was reasonable evidence from seven RCTs that venous ulcers heal more rapidly with compression than without. Wound Healing Society 2007. Available at:
http://www3.interscience.wiley.com/cgi-bin/fulltext/118605278/HTMLSTART
Reference
Compression therapy heals more venous leg ulcers than no compression therapy as well as decreases the healing time. Level of evidence = A. High compression is more effective than low compression. Level of evidence = A. Wound, Ostomy, and Continence Nurses Society - Professional Association.  2005, Available at: http://www.guideline.gov/search/searchresults.aspx?Type=3&txtSearch=venous+ulcers&num=20
Definition
None
Guidance
None
Transmission Format
TBD
Initial Population
All visits of patients aged 18 years and older with a diagnosis of VLU
Denominator
Equals Initial Population
Denominator Exclusions
None
Numerator
Visits of patients with a diagnosis of VLU who received adequate compression within the 12-month reporting period.
Numerator Exclusions
None
Denominator Exceptions
None
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
Not applicable