New Measures Aim to Improve Care of Stroke Patients

The American Heart Association/American Stroke Association has proposed recommendations that can be used to monitor the diagnosis and treatment of patients at stroke centers, and in turn, help improve the quality of care stroke patients receive.

The metrics, which are published in a scientific statement in Stroke: Journal of the American Heart Association, are being proposed to assist in the standardized designation of Comprehensive Stroke Centers. These centers would be expected to monitor new diagnostic and treatment metrics, in addition to the standard metrics now required for Primary Stroke Centers designated by The Joint Commission. Comprehensive Stroke Centers would provide a highly specialized and advanced level care, including neurosurgery and interventional neuroradiologic procedures for patients with ischemic strokes and hemorrhagic strokes.

The new metrics are based on experience with previous quality improvement initiatives, such as the AHA/ASA’s Get with the Guidelines program. Studies have documented that such initiatives improve patient care and outcomes when metrics are used to monitor the quality of care, according to Dana Leifer, MD, statement lead author and associate professor of neurology at Weill Cornell Medical College in New York.

Improving how quickly patients with ischemic and hemorrhagic strokes are diagnosed and treated is a cornerstone of the recommendations, said Leifer. Some of the standards include:

• Specifically tracking the percentage of ischemic stroke patients identified as eligible for tissue plasminogen activator (tPA) and appropriately treated within a 60 minute door-to-needle time (the time between a patient presenting at the hospital and being treated with tPA). tPA is the only clot-busting drug approved for treating ischemic strokes and is effective only when given within a few hours after onset of a stroke.
• Tracking the time from hospitalization to treatment to repair blood vessels for patients with a ruptured aneurysm; and
• Performing 90-day follow-up of ischemic stroke patients to assess their outcome after acute interventions, including treatment with tPA.

“Some of the metrics have stronger evidence supporting them or have greater clinical significance, and we designated these as core measures that Comprehensive Stroke Centers should all monitor,” said Leifer. “Initially, Comprehensive Stroke Centers may have the option to track only some of the other metrics, just as Primary Stroke Centers were only required to track a few measures at first. But by using our metrics as part of quality improvement efforts, over time hospitals should be able to improve the quality of the care that they give and improve patient outcomes.”

For more:

• Metrics for Measuring Quality of Care in Comprehensive Stroke Centers: Detailed Follow-Up to Brain Attack Coalition Comprehensive Stroke Center Recommendations (Stroke)
• High Doses of Painkillers Increase Stroke and Cardiac Risks (HCPLive)
• AHA 2010: Stroke Risk and Vitamin D Deficiency in African Americans (HCPLive)