Measure Description: Percentage of patients ≥18 y with CLTI-related wounds who undergo multidisciplinary evaluation to address wound care, offloading, infection management, revascularization, or palliation
Numerator	Patients who have a multidisciplinary approach, including at least 2 specialists to address infection, topical management or wound care, offloading, revascularization, and palliation where needed Note: As stated in the 2024 PAD guideline, a multispecialty care team is defined as a team of professionals representing different specialties and disciplines to assist in the evaluation and management of the patient with PAD. For the care of patients who also have CLTI, the team should include individuals who are skilled in endovascular revascularization, surgical revascularization, wound-healing therapies and foot surgery, and medical evaluation and care.
Denominator	Patients age ≥18 y with CLTI-related wounds
Denominator Exclusions	Patients in hospice care, patients who leave during hospitalization against medical advice, patients who die during hospitalization
Denominator Exceptions	Documentation of patient reason(s) for not providing a multidisciplinary team evaluation (eg, patient refusal, religious beliefs limiting care modalities, socioeconomic factors [eg, transportation, prescription benefits, finances], occupational requirements [eg, need for specialized shoe wear at work, inability to modify prolonged standing or walking at work, work hours disallow treatment]) Documentation of system reason(s) for not providing a multidisciplinary team evaluation (eg, lack of accessible services or specialists, lack of well-qualified support teams, lack of insurance coverage)
Measurement Period	12 mo
Sources of Data	EHR data Administrative data/claims (inpatient/outpatient claims) Administrative data/claims expanded (multiple sources) Paper medical record
Attribution	Facility
Care Setting	Inpatient Outpatient
Rationale
In the management of CLTI, there are disciplines that are essential and disciplines that are beneficial. The primary goal in tissue preservation and limb salvage in CLTI is revascularization, except in the setting of a nonviable limb.1,181 To optimize functionality, quality of life, wound healing, infection risk reduction, and pain management, team-based, multispecialty care is recommended for patients with CLTI and CLTI-related wounds. The provision of multidisciplinary modalities in a coordinated manner leads to patient-centered teams achieving complete wound healing and limb salvage. Many complex factors affect the structure and function of such teams, with the accessibility of needed specialists and support teams being paramount. In addition to vascular surgery, infectious diseases, orthopedics or podiatry, or plastic surgery, rehabilitation, diabetes management, orthotics, and prosthetics should be considered.1,181 Care coordination is important, with the establishment of structured and systematic communication techniques, such as case conferences or morbidity and mortality discussions, being ideal. In the absence of life-threatening sepsis, evaluation by a multidisciplinary care team should occur, and tactics of shared decision-making should be utilized, with a goal to evaluate all revascularization and therapeutic options for limb preservation and functional optimization. When this is not possible, palliative management of the limb, including continued wound care, pain control, or amputation, should be considered within the context of the multidisciplinary team.1,181
Clinical Recommendation(s)
2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease 1 In patients with CLTI, a multispecialty care team should evaluate and provide comprehensive care with goals of complete wound healing, minimizing tissue loss, and preservation of ambulatory status.182,183 (Class 1, Level of Evidence: B-NR) In patients with CLTI, an evaluation for revascularization options by a multispecialty care team is recommended before amputation (Table 15, PAD Guideline). (Class 1, Level of Evidence: C-EO) In patients with CLTI who require amputation, evaluation should be performed by a multispecialty care team (Table 15, PAD Guideline) to assess for the most distal level of amputation that facilitates healing and provides maximal functional ability.182,184-188 (Class 1, Level of Evidence: B-NR)

AACVPR indicates American Association of Cardiovascular and Pulmonary Rehabilitation; ABC, Association of Black Cardiologists; ACC, American College of Cardiology; AHA, American Heart Association; APMA, American Podiatric Medical Association; CLTI, chronic limb-threatening ischemia; EHR, electronic health record; PAD, peripheral artery disease; QM, quality measure; SCAI, Society for Cardiovascular Angiography and Interventions; SIR, Society of Interventional Radiology; SVM, Society for Vascular Medicine; SVN, Society for Vascular Nursing; SVS, Society for Vascular Surgery; and VESS, Vascular and Endovascular Surgery Society.