Top Things to Know: 2010 Performance Measures for Adults With PAD

1. Peripheral Arterial Disease (PAD) includes a diverse group of disorders that lead to progressive stenosis or occlusion, or aneurysmal dilation, of the aorta and its noncoronary branch arteries, including the carotid, upper extremity, visceral, and lower extremity arterial branches.
2. These PAD performance measures refer specifically to atherosclerotic stenosis or occlusion of the aorta and arteries supplying the lower extremities and abdominal aortic aneurysms (AAA).
3. PAD is a marker of systemic atherosclerosis and afflicts approximately 8 million people in the United States. The prevalence of PAD is approximately 12% of the adult population, with men being affected slightly more than women.
4. These PAD performance measures provide a critical disease-based opportunity to improve PAD clinical care and outcomes, which can be accomplished only if the use of risk-reduction interventions are measured.
5. Development was a multi-society collaboration spearheaded by the AHA and ACC, with the American College of Radiology, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Vascular Medicine, Society of Vascular Nursing and Society of Vascular Surgeons.
6. Each performance measure was placed into at least one of six relevant dimensions of care categories: risk assessment, diagnostics, patient education, treatment, self-management/compliance, and monitoring of disease status.
7. All performance measures developed by the AHA must meet each of the following criterion:
   1. useful in improving patient outcomes and are based on Class I recommendation: interpretable and actionable,
   2. precisely defined and valid in face, content, and construct, and
   3. can be implemented with reasonable effort and cost and in a reasonable time period.
8. A total of seven PMs (e.g., pay for performance, physician ranking, or public reporting programs) were defined: ankle brachial index, cholesterol-lowering medications, smoking cessation, antiplatelet therapy, supervised exercise, lower extremity vein bypass graft surveillance, and monitoring of AAA*.
9. In addition, there were two test measures designated for use in internal quality improvement programs only: vascular review of systems for lower extremity PAD and PAD “at risk” population pulse examination.
10. The seven performance measures will be submitted for endorsement to the National Quality Forum during the 2013 call for cardiovascular measures.

*Please see the full text document for the detailed specifications for each performance measure, including the numerator, denominator, period of assessment, method of reporting, sources of data, rationale, clinical recommendations, recommended level of attribution and/or aggregation, and challenges to implementation. A sample prospective data collection flowsheet is also provided.