Affiliation:
1. From the Department of Epidemiology (M.J.R., C.P.), Michigan State University, East Lansing, Mich; the Division of Cardiology (G.C.F.), University of California, Los Angeles, Calif; the Department of Clinical Neurosciences (E.E.S.), University of Calgary, Alberta, Canada; and the Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, Mass.
Abstract
Background and Purpose—
In the United States and elsewhere, stroke performance measures have been developed to monitor and improve the quality of care. The process by which these measures are developed, implemented, and evaluated is complex, evolving, and not widely understood. We review the methodological development of stroke performance measures in the United States.
Methods—
A literature search identified articles that addressed the development and endorsement of performance measures for stroke care. Emphasis was given to articles specific to acute stroke, but when these were lacking, other cardiovascular diseases were included.
Results—
Ten process-based performance measures relevant to acute hospital-based stroke care have now been developed and endorsed. These measures include intravenous thrombolysis, deep vein thrombosis prophylaxis, dysphagia screening, stroke education, and discharge-related medications and assessments. There are currently at least 5 major US-based stroke quality improvement programs implementing stroke measures. Data indicate that rapid improvements in the quality of stroke care can be induced by the systematic collection and evaluation of stroke performance measures. However, current stroke measures are relatively limited, addressing only inpatient care and mostly patients with ischemic stroke.
Conclusions—
Stroke quality improvement is still in its early stages, but data suggest that large-scale improvements in stroke care can result from the implementation of stroke performance measures. Performance measures that address multidisciplinary stroke unit care, outpatient-based care, and patient-oriented outcomes such as functional recovery should be considered. Ongoing challenges relevant to stroke quality improvement include the role of public reporting and the need to link better stroke care to improved patient outcomes.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Reference41 articles.
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.
2. The Joint Commission. Primary Stroke Centers—Stroke Performance Measurement. Available at: www.jointcommission.org/CertificationPrograms/PrimarystrokeCenters/stroke_pms.htm. Accessed December 14 2009.
3. Centers for Disease Control and Prevention. The Paul Coverdell National Acute Stroke Registry. March 13 2008. Available at: www.cdc.gov/DHDSP/stroke_registry.htm. Accessed February 12 2010.
4. American Stroke Association. Get with the Guidelines–Stroke. Available at: http://strokeassociation.org/presenter.jhtml?identifier=3002728. Accessed July 7 2009.
5. American Medical Association and National Committee for Quality Assurance. Physician Performance Measurement Set: Stroke and Stroke Rehabilitation. 2006. Available at: http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?doc_id=10247. Accessed May 11 2010.
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