Clinical Performance Measures for Adults Hospitalized With Intracerebral Hemorrhage: Performance Measures for Healthcare Professionals From the American Heart Association/American Stroke Association

Hemphill, J. Claude; Adeoye, Opeolu; Alexander, David N.; Alexandrov, Anne W.; Amin‐Hanjani, Sepideh; Cushman, Mary; George, Mary G.; LeRoux, Peter D.; Mayer, Stephan A.; Qureshi, Adnan I; Saver, Jeffrey L.; Schwamm, Lee H; Sheth, Kevin N; Tirschwell, David

doi:10.1161/str.0000000000000171

Cited by 45 publications

(27 citation statements)

References 30 publications

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“…'Home-time' may therefore underestimate disability owing to cognitive deficits, a shortcoming shared with traditional stroke outcome measures, such as the modified Rankin Scale score. 41 (15)(16)(17)(18)(19)(20) .006 25 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) .12…”

Section: Previous Results Demonstrate That 'Home-time' Correlatesmentioning

confidence: 99%

“…Subtype was defined in this manner for 2417 or 2.5% of patients; otherwise, we adhered to recommendations to code these patients as ischaemic stroke (ie, I64) 21 or intracerebral haemorrhage (ie, I62.9). 22 As previously reported, 18,19 patients were ineligible if resident outside NSW or if patients had concomitantly recorded major head trauma (ICD-10AM S04, S06, S07, S08, S17, S18, S01. were also excluded as missing hospitalisation data precluded accurate calculation of 'home-time'.…”

Section: What's Newmentioning

confidence: 97%

“…No 42 (42)(43) 21 (20)(21)(22) 31 (29)(30)(31)(32) Peripheral vascular disease Yes 39 (37)(38)(39)(40) <.001 18 (16)(17)(18)(19)(20) .01 30 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) .88…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…No 41 (40)(41)(42) 21 (20)(21)(22) 31 (29)(30)(31)(32) Dementia Yes 31 (29)(30)(31)(32) <.001 19 (16)(17)(18)(19)(20)(21)(22)(23) . 42 31 (21-48) .89…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…No 41 (40)(41)(42) 21 (20)(21)(22) 31 (30)(31)(32) Connective tissue disease Yes 39 (37)(38)(39)(40)(41)(42) . 12 20 (14-28) .81 38…”

Section: Comparison With Previous Workmentioning

confidence: 99%

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Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

et al. 2020

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Aims Administrative data offer cost‐effective, whole‐of‐population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke (‘home‐time’) is a patient‐centred outcome that can be objectively ascertained from administrative data. Population‐based validation against both severity and outcome measures and for all subtypes is lacking. We aimed to report representative ‘home‐time’ estimates and validate ‘home‐time’ as a surrogate measure of functional status after stroke. Methods Stroke hospitalisations from a state‐wide census in New South Wales, Australia, from January 1, 2005 to March 31, 2014 were linked to prehospital data, poststroke admissions and deaths. We correlated 90‐day ‘home‐time’ with Glasgow Coma Scale (GCS) scores, measured upon a patient's initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regressions identified predictors of ‘home‐time’. Results Patients with stroke (N = 74 501) spent a median of 53 days living at home 90 days after the event. Median ‘home‐time’ was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with ‘home‐time’ (P < .001). Women spent significantly less time at home compared with men after stroke, although being married increased ‘home‐time’ after ischaemic stroke and subarachnoid haemorrhage. Conclusions These findings underscore the immediate and adverse impact of stroke. ‘Home‐time’ measured using administrative data is a robust, replicable and valid patient‐centred outcome enabling inexpensive population‐based surveillance and system‐wide quality assessment.

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Section: Previous Results Demonstrate That 'Home-time' Correlatesmentioning

confidence: 99%

Section: What's Newmentioning

confidence: 97%

Section: Comparison With Previous Workmentioning

confidence: 99%

“…No 41 (40)(41)(42) 21 (20)(21)(22) 31 (29)(30)(31)(32) Dementia Yes 31 (29)(30)(31)(32) <.001 19 (16)(17)(18)(19)(20)(21)(22)(23) . 42 31 (21-48) .89…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…No 41 (40)(41)(42) 21 (20)(21)(22) 31 (30)(31)(32) Connective tissue disease Yes 39 (37)(38)(39)(40)(41)(42) . 12 20 (14-28) .81 38…”

Section: Comparison With Previous Workmentioning

confidence: 99%

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Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

et al. 2020

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Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke

et al. 2019

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Key Points Question Which processes of care are associated with reduced risk of mortality or recurrent stroke after transient ischemic attack or nonsevere ischemic stroke? Findings In this cohort study of 8076 patients with transient ischemic attack or nonsevere ischemic stroke, only 1216 (15.3%) received without-fail care, defined as receiving all guideline-concordant processes of care for which they were eligible (ie, brain imaging, carotid artery imaging, antihypertensive intensification, high- or moderate-potency statin therapy, antithrombotics, and anticoagulation for atrial fibrillation). Receiving all 6 processes was associated with lower risk of death (31.2% reduction at 1 year) but not lower risk of recurrent stroke. Meaning Clinicians should ensure that patients with transient ischemic attack and nonsevere ischemic stroke receive all guideline-concordant processes of care for which they are eligible.

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Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke

et al. 2018

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The timely delivery of guideline-concordant care may reduce the risk of recurrent vascular events for patients with transient ischemic attack (TIA) and minor stroke. Although many health care organizations measure stroke care quality, few evaluate performance for patients with TIA or minor stroke, and most include only a limited subset of guideline-recommended processes. OBJECTIVE To assess the quality of guideline-recommended TIA and minor stroke care across the Veterans Health Administration (VHA) system nationwide. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 8201 patients with TIA or minor stroke cared for in any VHA emergency department (ED) or inpatient setting during federal fiscal year 2014 (October 1, 2013, through September 31, 2014). Patients with length of stay longer than 6 days, ventilator use, feeding tube use, coma, intensive care unit stay, inpatient rehabilitation stay before discharge, or receipt of thrombolysis were excluded. Outlier facilities for each process of care were identified by constructing 95% CIs around the facility pass rate and national pass rate sites when the 95% CIs did not overlap. Data analysis occurred from January 16, 2016, through June 30, 2017. MAIN OUTCOMES AND MEASURES Ten elements of care were assessed using validated electronic quality measures. RESULTS In the 8201 patients included in the study (mean [SD] age, 68.8 [11.4] years; 7877 [96.0%] male; 4856 [59.2%] white), performance varied across elements of care: brain imaging by day 2 (6720/7563 [88.9%]; 95% CI, 88.2%-89.6%), antithrombotic use by day 2 (6265/7477 [83.8%]; 95% CI, 83.0%-84.6%), hemoglobin A 1c measurement by discharge or within the preceding 120 days (2859/3464 [82.5%]; 95% CI, 81.2%-83.8%), anticoagulation for atrial fibrillation by day 7 after discharge (1003/1222 [82.1%]; 95% CI, 80.0%-84.2%), deep vein thrombosis prophylaxis by day 2 (3253/4346 [74.9%]; 95% CI, 73.6%-76.2%), hypertension control by day 90 after discharge (4292/5979 [71.8%]; 95% CI, 70.7%-72.9%), neurology consultation by day 1 (5521/7823 [70.6%]; 95% CI, 69.6%-71.6%), electrocardiography by day 2 or within 1 day prior (5073/7570 [67.0%]; 95% CI, 65.9%-68.1%), carotid artery imaging by day 2 or within 6 months prior (4923/7685 [64.1%]; 95% CI, 63.0%-65.2%), and moderate-to high-potency statin prescription by day 7 after discharge (3329/7054 [47.2%]; 95% CI, 46.0%-48.4%). Performance varied substantially across facilities (eg, neurology consultation had a facility outlier rate of 53.0%). Performance was higher for admitted patients than for patients cared for only in EDs with the greatest disparity for carotid artery imaging (4478/5927 [75.6%] vs 445/1758 [25.3%]; P < .001). CONCLUSIONS AND RELEVANCE This national study of VHA system quality of care for patients with TIA or minor stroke identified opportunities to improve care quality, particularly for patients who were discharged from the ED. Health care systems should engage in ongoing TIA care performance assessment to complement existing stroke performance measu...

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Clinical Performance Measures for Adults Hospitalized With Intracerebral Hemorrhage: Performance Measures for Healthcare Professionals From the American Heart Association/American Stroke Association

Cited by 45 publications

References 30 publications

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke

Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke

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