Abstract P188: Comprehensive Center Metrics: A 2-Year and New Year Follow-up

Abstract

Background and Purpose: In 2005, the Brain Attack Coalition (BAC) published recommendations outlining elements of the highest level of stroke care and coined the term- Comprehensive Stroke Center. Six years later, international and national certifications are still not offered. Regional certifications are available in three U.S. states, based on affirmative responses to capability inquiries; with the quality assessment aspects identified by the Brain Attack Coalition being wholly disregarded. Quantifying quality at this highest level has proven difficult. Only one center in Houston, Texas has published the successful delineation and operationalization of thirteen Comprehensive level quality measures (2008). In February 2011, Leifer and colleagues published an additional set of twenty-six potential Comprehensive metrics that iterated some of the previously published measures and added new ones. This is a two year review of the original 2008 Texas Medical Center publication and a review of the more recent February 2011 metrics. Methods: Quality metrics for both 2008 and 2011 publications were derived from the Brain Attack Coalition Comprehensive Stroke Center guidelines. Metrics fell into one of two categories of Donabedian's quality measures: process or outcomes. The 2008 publication defined all measures recommended by the BAC that had reliable/valid benchmark thresholds. Inclusion and exclusion criteria were specified and delineated using industry standard identifiers/codes. The 2011 publication included core, optional, inpatient, and outpatient measures. Standardized (replicable) definitions for numerator and denominator elements, and quality thresholds were not indicated. Results: The mandatory reporting elements of the Comprehensive Stroke Centers are still being debated by the stroke care industry. And, operationalization of developing Comprehensive Center metrics continues to be challenging. Conclusions: As purported Comprehensive Stroke Centers advertise the highest level of technological and practitioner capability, they are obliged to demonstrate outcomes assessment reflecting Comprehensive level care. This review shows that Comprehensive metric monitoring is achievable and replicable.