Closing Gaps Between Evidence-Based Stroke Care Guidelines and Practices with a Collaborative Quality Improvement Project

Stoeckle-Roberts, Stacey; Reeves, Mathew J.; Jacobs, Bradley S.; Maddox, Kate; Choate, Lisa; Wehner, Susan; Mullard, Andrew J.

doi:10.1016/s1553-7250(06)32067-3

Cited by 36 publications

(78 citation statements)

References 19 publications

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“…[12][13][14][15] The metrics that we have proposed for CSCs should help provide a framework for establishing CSCs and a foundation for improving care once they are established.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Analysis of PSC performance has indicated that establishment of PSCs with concomitant development of formal protocols for stroke care and measurement of adherence to the metrics has been associated with improvement in stroke care. [12][13][14][15] Several states have now moved ahead with plans to certify CSCs. [7][8][9] In this setting, to help in the development of CSCs, we now propose a set of metrics and associated data elements that cover the major types of care that distinguish CSCs from PSCs.…”

Section: S Troke Is the Third-leading Cause Of Death In The Unitedmentioning

confidence: 99%

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

Leifer¹,

Bravata²,

Connors³

et al. 2011

Stroke

160

133

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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.)

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“…[12][13][14][15] The metrics that we have proposed for CSCs should help provide a framework for establishing CSCs and a foundation for improving care once they are established.…”

Section: Discussionmentioning

confidence: 99%

Section: S Troke Is the Third-leading Cause Of Death In The Unitedmentioning

confidence: 99%

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

Leifer¹,

Bravata²,

Connors³

et al. 2011

Stroke

160

133

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“…84 Another example showed that hospitals participating in the Paul Coverdell National Acute Stroke Registry had significant improvements in 9 of the 10 performance measures from 2005 to 2009, with one being that the average annual use of intravenous rtPA increased by 11%.…”

Section: Stroke Care Quality Improvement Process and Establishment Ofmentioning

confidence: 99%

“…83 By conducting process improvement programs, the Michigan Paul Coverdell National Acute Stroke Registry showed that documentation of the reasons for not giving intravenous rtPA increased by 13%. 84 Another example showed that hospitals participating in the Paul Coverdell National Acute Stroke Registry had significant improvements in 9 of the 10 performance measures from 2005 to 2009, with one being that the average annual use of intravenous rtPA increased by 11%. 85 Get With The Guidelines (GWTG)-Stroke, provided by the AHA/ASA, is a patient management and data collection tool that ensures continuous quality improvement of acute stroke treatment and stroke prevention.…”

Section: Stroke Care Quality Improvement Process and Establishment Ofmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,338

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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“…Several studies evaluating hospitals designated as PSC both before and after implementation of formal protocols, or compared with nonstroke center hospitals, have revealed improved performance and patient outcomes with PSC designation. [19][20][21][22][23] In 2005, the BAC released a second proposal calling for the development of CSCs with the capability of providing advanced and emergent interventions for patients with ischemic and hemorrhagic stroke. 24 The BAC defined CSC as a facility or system with the necessary personnel, infrastructure, expertise, and programs to diagnose and treat patients with stroke who require a high intensity of medical and surgical care, specialized tests, or interventional therapies.…”

Section: Strokementioning

confidence: 99%