Abstract WP389: Lack of Relationship Between Joint Commission Stroke Performance Measures and Functional Outcome in Ischemic Stroke

Abstract

Background Performance measures are used to encourage quality improvement, but there is little data that show performance measures improve post-stroke functional outcome. We sought to determine if adherence to Joint Commission (JC) performance measures is associated with a better functional outcome after ischemic stroke. Methods Ischemic stroke patients were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project between Nov. 2008 and June 2011. Data were abstracted from the medical records for the following performance measures (using 2008 JC criteria): DVT prophylaxis at 48 hours, discharged on antithrombotic therapy, anticoagulation for patients with atrial fibrillation, thrombolytic therapy administered, antithrombotic by hospital day 2, discharged on cholesterol reducing medication, and assessed for rehabilitation. Adherence to quality measures was defined by a either a binary defect free score indicating receipt of all of the measures a patient was eligible for or an opportunity score indicating the proportion of eligible measures received. Functional outcome was ascertained by patient or proxy interview as a total ADL/IADL score at 90 days post-stroke, with higher scores indicating poorer function (range 22-88). Tobit regression was used to estimate the effects of adherence to quality measures on functional outcome with adjustment for age, gender, pre-stroke functional and cognitive status, ethnicity, stroke severity, medical comorbidities, education, and clustering of patients within hospital. Results At total of 379 ischemic stroke patients were included. The median age was 68 and 52% of patients were women. 33.8% of patients had defect free care and the median opportunity score was 0.8 (IQR: 0.67-1). In the final multivariable models, defect free care (B -1.04, SE 2.24, p=0.66) and the opportunity score (B 1.80, SE 5.38, p=0.74) were not associated with functional outcome. Conclusions In this population, meeting JC performance measures was not associated with improvement in post-stroke functional outcome. While process based measures are important and improve adherence to guideline recommended care, these measures may not lead to improved functional outcome, a measure that patients and families value.