doi: 10.1161/hs0901.94620
(Stroke. 2001;32:2058.)
© 2001 American Heart Association, Inc.
Original Contributions |
Development of Performance Measures for Acute Ischemic Stroke
From the Department of Neurology (R.G.H., C.B., J.A.H.), University of Rochester School of Medicine and Dentistry; the Department of Community and Preventive Medicine (R.G.H.), University of Rochester School of Medicine and Dentistry, Rochester, NY; the Department of Neurology, University of California (B.G.V.), Los Angeles, Los Angeles, Calif; and the American Academy of Neurology (J.B.), St. Paul, Minn.
Correspondence to Robert G. Holloway, University of Rochester School of Medicine and Dentistry, Department of Neurology, 1351 Mt Hope Ave, Ste 216, Rochester, NY 14620. E-mail bholloway{at}mct.rochester.edu
Background and Purpose—— The purpose of the present study was to develop and rate performance measures for hospital-based acute ischemic stroke.
Methods—— A national multidisciplinary panel of 16 individuals (2 stroke specialists, 2 general neurologists, 2 internists, 2 neuroscience nurses, 2 stroke advocacy organization representatives, 1 stroke rehabilitationist, 1 family practitioner, 1 emergency room physician, 1 neuroradiologist, 1 managed care organization director, and 1 hospital association representative) from 10 medical societies or lay organizations assisted in the development of 44 potential stroke performance measures. We developed evidence summaries for each of the performance measures and graded the level of evidence associated with each measure. The panel received a summary of the literature pertaining to each measure and rated the measures by use of a modified Delphi approach for 6 dimensions of quality, including validity of evidence, feasibility, impact on outcomes, room for improvement, plausibility, and an overall rating (little reason to do, could do, should do, and must do).
Results—— Highly rated and agreed on performance measures for the overall rating include warfarin in atrial fibrillation, antithrombotics on hospital discharge, carotid imaging in appropriate patients, and use of stroke units. Additional measures notable for high agreement were heparins for deep-vein thrombosis prophylaxis and use of a stroke protocol. Panelists rated time-related thrombolytic measures such as head CT within 25 minutes highly on the room for improvement dimension but low on the overall dimension. Neurologists tended to rate measures lower than did nonneurologists (P<0.01) for all 9 measures pertaining to thrombolytic management.
Conclusions—— Highly rated and agreed on performance measures exist in all domains of hospital-based stroke care.
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