ACCF/AHA New Insights Into the Methodology of Performance Measurement

Spertus, John A.; Bonow, Robert O.; Chan, Paul S.; Diamond, George A.; Drozda, Joseph P.; Kaul, Sanjay; Krumholz, Harlan M.; Masoudi, Frederick A.; Normand, Sharon‐Lise T.; Peterson, Eric D.; Radford, Martha J.; Rumsfeld, John S.; DeLong, Elizabeth R.; Erwin, John P.; Goff, David C.; Grady, Kathleen L.; Green, Lee A.; Heidenreich, Paul A.; Jenkins, Kathy J.; Loth, Ann R.; Shahian, David M.

doi:10.1161/cir.0b013e3181f7d78c

Cited by 74 publications

(41 citation statements)

References 49 publications

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“…7,17,18 The committees first selected the definition of stroke and care period, then reviewed the existing AHA/ASA guideline recommendations for suitability for conversion into performance measures, based on the strength of the supporting evidence, feasibility of data collection, reliability for comparisons across sites, and potential to improve patient health outcomes. Next, suitable guideline recommendations were converted into corresponding performance measures with exact specifications of patient inclusion and exclusion criteria and measure numerators and denominators.…”

Section: Methodsmentioning

confidence: 99%

“…18,22 Additionally, outcome measures require risk adjustment to account for hospital differences in patient case mix, and the single most important prognostic variable for stroke outcome, stroke severity, is not routinely recorded in a standardized fashion in routine clinical practice. 23 The committee encourages policies to promote documentation of presenting stroke severity, including creation of a stroke severity documentation performance measure, so that this crucial prognostic variable will be more widely available for use for risk adjustment for potential future outcome measures.…”

Section: Dimensions Of Carementioning

confidence: 99%

“…The ballots allowed measures to be rated on these dimensions: evidenced-based, interpretable, actionable, design of numerator and denominator, reliability, validity, and feasibility for implementation. 18 For each of these dimensions, the ballot respondent indicated a score on a Likert scale that ranged from 1 (strongly disagree) to 5 (strongly agree). As well, an overall recommendation for inclusion, ranging from 1 (do not include) to 5 (must include), was provided.…”

Section: Definition and Selection Of Measuresmentioning

confidence: 99%

“…The importance of feasibility of data collection, and thus data collection methods, has been underscored by inclusion of this attribute in formal evaluation criteria of existing and proposed performance measures. 7,18 To maximize the reliability of data capture, a prospectively designed report form should be used. Increasingly, hospitals and healthcare systems are moving toward electronic health records, which can be used to automatically capture data elements.…”

Section: Data Collectionmentioning

confidence: 99%

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Clinical Performance Measures for Adults Hospitalized With Acute Ischemic Stroke

Smith¹,

Saver²,

Alexander³

et al. 2014

Stroke

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T o work toward the goal of building healthier lives, free of cardiovascular diseases and stroke, the American Heart Association (AHA) and American Stroke Association (ASA) have developed a multifaceted strategy for improving the quality of care for stroke. A key feature of this strategy is the development of professional guidelines for evidence-based stroke care. Recommendations are provided for acute management, primary and secondary prevention, rehabilitation, stroke systems of care, and other domains of stroke care. 1-4The strength of the evidence supporting these recommendations is given, according to a specified grading system. For many aspects of care, there is widespread consensus that the intervention is beneficial, usually supported by strong scientific evidence including randomized controlled trials.Professional guidelines improve the delivery of evidencebased care; however, despite these guidelines, gaps between best evidence-based practice and actual practice persist.5 To close these gaps in quality of care, several organizations have developed systems to allow practitioners and healthcare organizations such as hospitals to quantify the quality of their care through performance measures. A performance measure is defined by the Agency for Healthcare Research and Quality as a "mechanism for assessing the degree to which a provider competently and safely delivers the appropriate clinical services to the patient within the optimal time period." 6 The AHA and American College of Cardiology Foundation have additionally suggested that performance measures should be based on the highest level of supportive evidence and have the greatest impact on health outcomes.7 Performance measures, in addition to supporting quality improvement activities, are specifically suitable for public reporting, external comparisons, and possibly pay-for-performance programs.As steward of the professional guidelines for stroke care, with a large group of volunteer expert clinicians with expertise in guideline creation and performance measurement, the AHA/ASA is uniquely positioned to develop high-quality performance measures based on the guidelines. Accordingly, in 2011 the AHA/ASA formed the Stroke Performance Oversight Committee to oversee development of stroke performance measures and quality metrics. Writing committees were commissioned for different domains of stroke care based on the care setting and type of cerebrovascular disease (eg, ischemic stroke versus intracerebral hemorrhage), roughly corresponding to the topics of the highest-impact professional guideline statements.8 This document provides the results of the writing committee on acute inpatient management of ischemic stroke.The primary intended purpose of these performance measures is to facilitate improved adherence to guideline-recommended care. The writing committee hopes that healthcare providers, healthcare organizations, and payers, such as the Centers for Medicare and Medicaid Services (CMS), may find these measures useful to measure and improve their qual...

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Section: Methodsmentioning

confidence: 99%

Section: Dimensions Of Carementioning

confidence: 99%

Section: Definition and Selection Of Measuresmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Performance Measures for Adults Hospitalized With Acute Ischemic Stroke

Smith¹,

Saver²,

Alexander³

et al. 2014

Stroke

View full text Add to dashboard Cite

show abstract

“…The approach used by most AHA/ACC performance measure writing committees and that used in this SCD performance measure set to account for shared decision making is to exclude patients who made informed decisions to decline medications or devices, as documented by the clinician, from the denominator of the measure, with an exception for patient reasons. 114 Other measurement designs have been advocated, such as including patients who decline to receive a therapy in the numerator equivalent to receiving the therapy, as well as accounting for patients who remain undecided and want to continue deliberations. 115 Determining whether shared decisionmaking has been adequately provided depends on documenting the extent to which a patient has been provided information on the risks and benefits of a therapy, there has been collaborative engagement in the decision-making process, and the patientʼs preferences and values were fully considered.…”

Section: Shared Decision-making and Shared Accountabilitymentioning

confidence: 99%