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 neck pain/injury measured via the validated Neck Disability Index (NDI). 
Measure ID: IROMS15

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 NDI 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 NDI) proportion will reported.

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

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

Measure Description: The proportion of patients failing to achieve an MCID of ten (10) points or more improvement in the NDI change score for neck pain/injury patients treated during the observation period will be reported. Additionally, a risk-adjusted NDI 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 NDI score, baseline pain score, age, sex, payer, and symptom duration (time from surgery or injury to baseline physical therapy visit).

Denominator Description: The number of neck pain/injury patients 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 neck pain/injury to not achieve an MCID in their NDI change score (MCID >10) 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