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(Stroke. 2008;39:1619.)
© 2008 American Heart Association, Inc.

Research Letters

Benchmarks and Determinants of Adherence to Stroke Performance Measures

Judith A. Hinchey, MD, MS; Timothy Shephard, PhD, RN; Sarah T. Tonn, MS; Robin Ruthazer, MS; Harry P. Selker, MD, MS David M. Kent, MD, MS

From the Institute of Clinical Care Research and Health Policy Studies (J.A.H., R.R., H.P.S., D.M.K.) Tufts-New England Medical Center, Boston, Mass; Stroke System Consulting (T.S.), Charlottesville, Va; and the American Academy of Neurology (S.T.T.), Saint Paul, Minn.

Correspondence to Judith A. Hinchey, MD, Institute of Clinical Care Research and Health Policy Studies Tufts-New England Medical, 750 Washington St. Box 63, Boston, MA 02111. E-mail Judith.hinchey{at}caritaschristi.org

Abstract

Background and Purpose— Develop achievable benchmarks for 9 stroke performance measures (PM) and to identify organizational factors associated with adherence.

Methods— Adherence rates and achievable benchmarks were determined for 9 PM within a study of patients (n=2294) admitted with acute ischemic stroke at 17 hospitals. Baseline information regarding hospital characteristics and stroke-specific processes of care were collected, and multi-level models were used to test the association of these factors with adherence.

Results— Benchmarks were 90% for 8 of the 9 PM. After controlling for clustering, only use of standing orders was associated with adherence to PM, including: dysphagia screening, venous thrombosis prophylaxis, consideration of tPA, and provision of educational material.

Conclusion— High levels of adherence are achievable for several acute stroke PM. Use of standing orders is associated with adherence to PM requiring immediate action on admission.

Key Words: delivery of health care • practice improvement • quality of health care • process assessment (health care) • cerebral infarction