Measure Title: Failure to Progress (FTP): Proportion of patients failing to achieve a Minimal Clinically Important Difference (MCID) to indicate functional improvement in rehabilitation of patients with arm, shoulder, and hand injury measured via the validated Disability of Arm Shoulder and Hand (DASH) score, Quick Disability of Arm Shoulder and Hand (QDASH) score, or equivalent instrument which has undergone peer reviewed published validation and demonstrates a peer reviewed published MCID.
Measure ID: IROMS19

High Priority Measure
Measure Type: Patient Reported Outcome
NQS Domain: Effective Clinical Care
Meaningful Measure: Functional Outcomes
Risk Adjusted: Yes
Inverse Measure: yes
Proportional Measure: yes
Continuous Variable: No
Ratio Measure: No
Overall Performance Rate: 2nd Performance Rate

Six measures will be reported, two overall performance measures and four stratified performance measures are to be included:

1) Overall proportion of patients achieving an MCID in DASH change score will be reported.
2) A risk-adjusted MCID proportional difference will be reported where the difference between the risk model predicted and observed MCID (measured via DASH) proportion will reported.

For operative (surgical) patients:
3) The proportion of patients not achieving an MCID in DASH change score will be reported.
4) A risk-adjusted MCID proportional difference will be reported where the difference between the risk model predicted and observed MCID (measured via DASH) proportion will reported.

For non-operative (non-surgical) patients:
5) The proportion of patients not achieving an MCID in DASH change score will be reported.
6) A risk-adjusted MCID proportional difference will be reported where the difference between the risk model predicted and observed MCID (measured via DASH) proportion will reported.


Measure Description: The proportion of patients failing to achieve an MCID of ten (10) points or more improvement in the DASH change score or eight (8) points or more improvement in the QDASH change score for patients with arm, shoulder, and hand injury patients treated during the observation period will be reported.

Additionally, a risk-adjusted DASH change proportional difference will be determined by calculating the difference between the risk model predicted and observed MCID proportion will reported for each physical therapist or physical therapy group. The risk adjustment will be calculated using a logistic regression model using: baseline MDQ score, baseline pain score, age, sex, payer, and symptom duration (time from surgery or injury to baseline physical therapy visit).

These measures will serve as a physical and occupational therapy performance measure at the eligible physical or occupational therapist or physical or occupational therapy group level.

Denominator Description: The total number of surgical patients with arm, shoulder, or hand injury evaluated and treated by a physical therapist (PT) or Occupational Therapist (OT), or PT or OT Group, during the observation window.
Numerator Description: The total number of patients with arm, shoulder, or hand injuries to not achieve an MCID in their DASH change score (MCID >10 for DASH, MCID>8 for QDASH) from their initial visits to their final visits in PT/OT practice or PT/OT group during the observation window.
Denominator Exclusions: Exclude patients who did not complete 2 or more surveys.Patients will be excluded if they are non-English speaking and translation services are not available, if they are unable to read or have a mental impairment that compromises their understanding.
Denominator Exceptions: PT/OT can use their clinical judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress