Metrics for Measuring Quality of Care in Comprehensive Stroke Centers: Detailed Follow-Up to Brain Attack Coalition Comprehensive Stroke Center Recommendations

Abstract

Background-Stroke is a major cause of disability and death. The Brain Attack Coalition has proposed establishment of primary and comprehensive stroke centers to provide appropriate care to stroke patients who require basic and more advanced interventions, respectively. Primary stroke centers have been designated by The Joint Commission since 2003, as well as by various states. The designation of comprehensive stroke centers (CSCs) is now being considered. To assist in this process, we propose a set of metrics and related data that CSCs should track to monitor the quality of care that they provide and to facilitate quality improvement. Methods and Results-We analyzed available guideline statements, reviews, and other literature to identify the major features that distinguish CSCs from primary stroke centers, drafted a set of metrics and related data elements to measure the key components of these aspects of stroke care, and then revised these through an iterative process to reach a consensus. We propose a set of metrics and related data elements that cover the major aspects of specialized care for patients with ischemic cerebrovascular disease and nontraumatic subarachnoid and intracerebral hemorrhages at CSCs. Conclusions-The metrics that we propose are intended to provide a framework for standardized data collection at CSCs to facilitate local quality improvement efforts and to allow for analysis of pooled data from different CSCs that may lead to development of national performance standards for CSCs in the future. (Stroke. 2011;42:849-877.)

Microcatheter to Recanalization (Procedure Time) Predicts Outcomes in Endovascular Treatment in Patients with Acute Ischemic Stroke: When Do We Stop?

“…However, the basic elements necessary for recognition and improvement have not been identified either through the consensus of experts or clinical studies. The comprehensive stroke center metrics 17 identify "time to microcatheter" as a recommended metric to monitor but did not specify the thresholds for acceptable performance. The selection of time to microcatheter was based on a similar performance metric, "door to balloon," in patients with acute myocardial infarction.…”

Validation of Stroke Meaningful Use Measures in a National Electronic Health Record System

“…1,2 The Joint Commission requires eight quality measures in its Primary Stroke Center certification program, those participating in the Get With the Guidelines program from the American Stroke Association need to report these eight and other quality measures, and the Centers for Medicare and Medicaid now publicly report ischemic stroke mortality and readmissions on their Hospital Compare website. 3 The Affordable Care Act included the eight stroke indicators in its Meaningful Use (MU) program, 4 which provides incentives to institutions whose electronic health records (EHRs) are able to automatically collect and report hospital-based quality measures without manual chart review.…”

Developing practice recommendations for endovascular revascularization for acute ischemic stroke

“…4 Intra-arterial (IA) thrombolysis has not received FDA approval, but randomized trials and several case series have led to endorsements by multiple associations for select patients. [5][6][7][8][9] Endovascular revascularization therapy (ERT) currently has a Class Ib recommendation for IA thrombolysis for select patients and a Level IIb recommendation for mechanical thrombus extraction in the American Heart Association (AHA) guidelines. [1][2][3][4][5][6][7][8][9] Two device families have FDA approval for ERT: the Merci Retriever (Concentric Medical, Inc., Mountain View, CA) and the Penumbra Aspiration System (Penumbra Inc., Alameda, CA); and multiple new devices are rapidly approaching FDA approval and market availability.…”

“…[5][6][7][8][9] Endovascular revascularization therapy (ERT) currently has a Class Ib recommendation for IA thrombolysis for select patients and a Level IIb recommendation for mechanical thrombus extraction in the American Heart Association (AHA) guidelines. [1][2][3][4][5][6][7][8][9] Two device families have FDA approval for ERT: the Merci Retriever (Concentric Medical, Inc., Mountain View, CA) and the Penumbra Aspiration System (Penumbra Inc., Alameda, CA); and multiple new devices are rapidly approaching FDA approval and market availability. 10,11 Established guidelines and recommendations are available for the early treatment of adults with AIS 1 and for the development of comprehensive stroke centers 7 and training standards for endovascular ischemic stroke treatment.…”