Measure Title: Failure to Progress (FTP): Proportion of patients not achieving a Minimal Clinically Important Difference (MCID) to indicate functional improvement in rehabilitation of patients with hip, leg or ankle injuries using the validated Lower Extremity Function Scale (LEFS) score, or equivalent instrument which has undergone peer reviewed published validation and demonstrates a peer reviewed published MCID.
Measure ID: IROMS13

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 not achieving an MCID in KOS 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 KOS) proportion will reported.

For operative (surgical) patients:
3) The proportion of patients not achieving an MCID in KOS 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 KOS) proportion will reported.

For non-operative (non-surgical) patients:
5) The proportion of patients not achieving an MCID in KOS 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 KOS) proportion will reported.


Measure Description: The proportion of patients failing to achieve an MCID of nine (9) points or more improvement in the LEFS change score for patients with hip, leg, or ankle injuries treated during the observation period will be reported. Additionally, a risk-adjusted MCID 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 LEFS score, baseline pain score, age, sex, payer, and symptom duration (time from surgery or injury to baseline physical therapy visit).

Denominator Description: The total number of patients with hip, leg, or ankle injury evaluated and treated by a physical therapist (PT) or Occupational Therapist (OT), or PT or OT Group.
Numerator Description: The total number of patients with hip, leg, or ankle injuries to not achieve an MCID in their LEFS change score (MCID ≥ 9) from their initial visit to their final visit 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.