Foot & Ankle International - 2017 FAI Supplement - 52S

is unclear; it may reflect the quality of presented material or
commitment to publication by the authors. The top journal for
podium and poster abstracts was FAI, indicating the presentations' specialty-focus.
Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00050
©The Author(s) 2017

Quality Measures in Foot and Ankle
Care
Grace Xiong, BA, Loretta Chou, MD, Chase
Bennett, MD, Robin Kamal, MD
Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion,
Diabetes, Hindfoot, Trauma
Keywords: quality measures; value-based models; national
quality forum; national quality strategy; donabedian domains
Introduction/Purpose: National healthcare delivery systems are shifting to value-based models. Understanding
quality measures used to assess performance is important
as they may be operationalized in alternative payment
models, such as bundled payment programs, or quality
reporting programs, such as the Merit-Based Incentive
Payment System. Previous literature has shown that quality measures in other orthopaedic subspecialties disproportionately focus on effective clinical care or processes of
care, while ignoring patient outcomes. We completed a
systematic review of quality measures and candidate quality measures that address foot and ankle care to identify
gaps in current measures and to inform future measure
development initiatives.
Methods: We conducted a systematic review of the National
Quality Forum, the Agency for Healthcare Research and
Quality, and the Physician Quality Reporting System for
quality measures related to foot and ankle care. We also
reviewed candidate quality measures from clinical practice
guidelines (CPG) in the literature meeting Institute of
Medicine CPG criteria. Measures were classified by clinical
entity, Donabedian domain (structure, process, or outcome),
and the National Quality Strategy (NQS) priority that they
addressed.
Results: We identified 12 quality measures and 16 candidate measures. Quality measures addressed NQS priorities
of "Effective Clinical Care" (33%), "Communication and
Coordination of Care" (58%), "Patient Safety" (25%),

52S

"Community and Population Health" (8%), and "Person
and Caregiver Centered Experience and Outcomes" (8%).
All candidate measures addressed "Effective Clinical
Care". Furthermore, 83% of quality measures and 94% of
candidates were process measures, 17% of quality and 6%
of candidate were outcome measures, and there were no
structure measures. Diabetic foot care was the most commonly addressed clinical entity for both quality measures
(58%) and candidate measures (69%).
Conclusion: Foot and ankle quality measures and candidate measures disproportionately assess effective clinical
care and processes of healthcare delivery. Additionally,
few clinical disorders within the field are included, focusing primarily on diabetic foot care. Currently only two outcome measures exist, leaving an opportunity for outcome
measure development. These patterns are reflected in candidate measures, suggesting that the narrow focus of quality measures will continue unless efforts are made to
develop more comprehensive measures. Additional measures that address a broader array of clinical disorders
across the spectrum of NQS priorities and Donabedian
domains are needed to prepare for a quality-based healthcare system.
Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00051
©The Author(s) 2017

Rates of Acute and Delayed Achilles
Repair: Changes in Practice Secondary
to an RCT Study
Alastair Younger, MB ChB, ChM, FRCSC, Sam
Si-Hyeong Park, MD, Andrea Veljkovic, MD,
FRCS(C), Murray Penner, MD, FRCS(C), Kevin
Wing, MD, FRCS(C)
Category: Sports, Trauma
Keywords: achilles tendon rupture delayed repair outcomes
Introduction/Purpose: The need for repair of the ruptured
achilles tendon has been discussed extensively in recent literature. A landmark paper in 2010 (Willits JBJS) outlined
that the re-rupture rates were similar in surgical and non surgically treated Achilles tendon ruptures. However concern
has to be raised as to the strength of the muscle tendon complex if the tendon is too long, potentially increasing the rate
of late repair. This paper analyses the rate of acute achilles
tendon repair and delayed repair before and after the 2010
publication of the Willits paper.

Foot & Ankle International 38(1S)

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