Measure #1a: Essential Components of Electrodiagnostic (EDX) Evaluation for Median Neuropathy at the Wrist

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Tracey Howard
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1 Measure #1a: Essential Components of Electrodiagnostic (EDX) Evaluation for Median Neuropathy at the Wrist Measure Description Percentage of patients referred for EDX evaluation of CTS who had adequate Nerve Conduction Studies (NCS) performed. Adequate NCS include: 1. Sensory/mixed nerve conduction study of the symptomatic median nerve to include: peak latency or conduction velocity and amplitude OR unobtainability; AND 2. Motor nerve conduction study of the symptomatic median nerve to include: distal latency, amplitude and forearm Nerve Conduction Velocity (NCV) OR unobtainability; AND 3. Additional upper extremity nerve conduction studies to exclude other neuropathic conditions; AND if indicated 4. Sensory/mixed nerve NCS internal comparison study of median and EITHER the ipsilateral ulnar or radial nerve at the same distance to include measurements of peak latency and amplitude; OR motor internal comparison study of the median and ulnar distal latencies (recording second lumbrical/first palmar interosseous respectively) Measure Components Exceptions All patients with suspected CTS who had adequate EDX ( as defined in measure description) All patients with suspected CTS who underwent EDX studies Patient reason: study stopped before completion at patients request Systems reason: power failure during EDX, communication barrier Medical reason: EDX physician recognizes an alternative diagnosis Supporting Guidelines & Other References Measure Importance Relationship to desired outcome Accurate diagnosis, exclusion of mimic, choice of appropriate treatment Opportunity for Improvement IOM Domains of Health Care Quality Addressed Exception Justification Safe Efficient Effective Harmonization with

2 Existing Measures Measure Designation Measure purpose Quality improvement Accountability Type of measure Process Level of Measurement Individual practitioner Care setting Ambulatory care Inpatient Data source Medical record Technical Specifications: (Eligible Population)

3 Measure #1b: Hand Temperature Measured and Maintained during Electrodiagnostic (EDX) Testing Measure Description Percentage of EDX studies on patients referred for evaluation of CTS in whom hand temperature was maintained at or above 32 degrees Celsius. Measure Components Exceptions EDX studies on patients referred for evaluation of CTS where hand temperature was maintained at or above 32 degrees Celsius. All EDX studies for suspected CTS. Patient exception documented inability to maintain hand temperature despite reasonable attempts at warming Supporting Guidelines & Other References Measure Importance Relationship to desired outcome Accurate data, accurate diagnosis and assessment of severity Opportunity for Improvement IOM Domains of Health Care Quality Addressed Exception Justification Effective Harmonization with Existing Measures Measure Designation Measure purpose Quality improvement Accountability Type of measure Process Level of Measurement Individual practitioner Care setting Ambulatory care Inpatient Data Source Medical records

4 Technical Specifications (Eligible Population)

5 Measure #2a: Electrodiagnostic Criteria for diagnosing Median Neuropathy at the Wrist Measure Description Percentage of EDX reports that provide a diagnosis of median neuropathy at the wrist which describe EDX data supporting the diagnosis as defined below*. *EDX criteria supporting a diagnosis of median neuropathy at the wrist include at least TWO of #1, #2, #3 AND #4: 1. Median sensory prolonged peak latency or conduction velocity slowing with or without amplitude reduction, OR absent median sensory response; 2. Prolonged median motor distal latency with or without reduced response amplitude; 3. Internal comparison studies showing relative prolongation of the median sensory/mixed peak latency in comparison to EITHER the ipsilateral ulnar or radial nerve at the same distance; OR relative prolongation of the median distal latency on motor internal comparison study of the median and ulnar nerves (recording second lumbrical/first palmar interosseous respectively. AND 4. Additional upper extremity nerve conduction studies exclude other neuropathic conditions. Normal reference values for the laboratories should be based on available databases where the method specifications are rigorously replicated OR rigorously defined reference values obtained in the EDX laboratory. Measure Components Exceptions/Exclusions Supporting Guidelines & Other References EDX reports that are consistent with median neuropathy at the wrist which describe EDX findings/data supporting the diagnosis of median neuropathy at the wrist (as defined above). All EDX reports that are consistent with a diagnosis of median neuropathy at the wrist. Medical reason: EDX reports that do not pertain to a median neuropathy at the wrist (i.e., EDX reports for other diagnoses). Medical reason: History and/or examination are consistent with CTS, and at least one of 1, 2, 3 is abnormal. Patient reason: study stopped before completion at patients request Systems reason: power failure during EDX, communication barrier Measure Importance Relationship to desired outcome Accurate diagnosis, choice of appropriate treatment Opportunity for Improvement IOM Domains of Health Care Quality Addressed Safe Efficient Effective

6 Exception Justification Harmonization with Existing Measures Measure Designation Measure purpose Quality improvement Accountability Type of measure Process Level of Measurement Individual practitioner Care setting Ambulatory care Inpatient Data source Medical record Technical Specifications: (Eligible Population)

7 Measure 2b: Electrodiagnostic (EDX) Criteria for Diagnosing Severe Median Neuropathy at the Wrist Measure Description Percentage of EDX reports consistent with severe median neuropathy at the wrist that describe data supporting this diagnosis as defined below.* *EDX criteria supporting a diagnosis of severe median neuropathy at the wrist include 1. Absent median sensory response AND EITHER A. Median motor nerve conduction study demonstrating prolonged distal latency and reduced compound motor action potential (CMAP) amplitude OR absent CMAP OR B. Needle electromyography showing: Ongoing denervation in the median innervated thenar muscles but not non-median innervated C8-T1 muscles; **Measures 1a, 1b and 2a need to be satisfied. Measure Components Exceptions Supporting Guidelines & Other References EDX reports that are consistent with severe median neuropathy at the wrist which describe EDX findings/data supporting the diagnosis of severe median neuropathy at the wrist (as defined above). All EDX reports that are consistent with a diagnosis of severe median neuropathy at the wrist. Medical Reason: EDX reports that do not pertain to median neuropathy at the wrist (i.e., EDX reports for other diagnoses). Patient reason: study stopped before completion at patients request Systems reason: power failure during EDX, communication barrier Measure Importance Relationship to desired outcome Opportunity for Improvement IOM Domains of Health Care Quality Addressed Exception Justification Safe Efficient Effective Harmonization with Existing Measures

8 Measure Designation Measure purpose Type of measure Level of Measurement Care setting Ambulatory Inpatient Data Source Technical Specifications (Eligible Population)

9 Measure #3: Preoperative Electrodiagnostic (EDX) Testing for Carpal Tunnel Syndrome Measure Description Percentage of patients undergoing surgery for CTS who had EDX testing within 12 months prior to surgery. Measure Components Exceptions Supporting Guidelines & Other References Number of patients with CTS undergoing carpal tunnel release who had EDX performed within 12 months prior to surgery. All patients with CTS who underwent carpal tunnel release Medical reason: alternative confirmative test performed (ultrasound/mri) Patient reason: declined EDX Systems reason: EDX not available, insurance coverage Measure Importance Relationship to desired outcome Appropriate diagnosis is necessary before invasive procedures are performed. Opportunity for Improvement IOM Domains of Health Care Quality Addressed Exception Justification Safe Timely Effective Efficient Patient centered Equitable Harmonization with Existing Measures Measure Designation Measure purpose Quality improvement, accountability Type of measure Process Level of Measurement Individual practitioner Care Setting Ambulatory care Inpatient

10 Data source Medical record Technical Specifications: (Eligible Population)

Motor and sensory nerve conduction studies

Motor and sensory nerve conduction studies 3 rd Congress of the European Academy of Neurology Amsterdam, The Netherlands, June 24 27, 2017 Hands-on Course 2 Assessment of peripheral nerves function and structure in suspected peripheral neuropathies