Abstract WP49: Clinical Performance Measures For Emergency Department Care For Adults With Nontraumatic Intracranial Hemorrhage

Abstract

Study Objective: Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage (ICH), Emergency Departments (EDs) lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative (E-QUAL). Methods: We convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure (internal quality improvement [QI], benchmarking, or accountability) and examined data from E-QUAL-participating EDs to consider the validity and feasibility of proposed measures. The initially conceived set included 14 measure concepts of which 7 were selected for inclusion in the measure set after review of data and further deliberation. To inform the process, we collected data from E-QUAL participating EDs. EDs used a web-based portal to submit data from chart reviews on patients with ICH during 2020-2021. Descriptive statistics characterize performance and identify variation. Results: Proposed measures include 2 for QI, benchmarking, and accountability, 3 for QI and benchmarking and 2 for QI only (Table). Of the E-QUAL participating EDs, 35 had sufficient case volume (≥25) and were included for review of preliminary performance data. Median annual ED volume was 44,000 (IQR 31,337-67,000) and 16 (48%) reported typically transferring patients with ICH. The Table includes available performance data. Conclusion: Application of these measures may identify opportunities for improvement and focus QI resources on evidence-based targets. The proposed measures warrant further development and validation to support broader implementation and advance national healthcare quality goals.