Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation
Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months.
-
Individual Clinician
Measure Info
ACP does not support “Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation” for application at the individual physician level. Since the numerator calls for one or more aspects of a neurological exam based on clinical decision-making, it is difficult to gauge where there are opportunities for improvement. While the monofilament exam has sufficient evidence to support its use, there is a lack of evidence for combining an annual monofilament exam with any of the items in the lower extremity neurological exam as defined in the numerator. There is insufficient evidence to suggest that regular, comprehensive lower extremity neurological examinations in the primary care setting improves outcomes for asymptomatic patients. Additonally, there are other neurological assessment tools that successfully diagnose neurological deficits in diabetic patients. The numerator is well-specified but does not seem easily implementable. Elements of the neurological exam are difficult to capture in structured fields, thereby adding a significant documentation burden.