Comprehensive Stroke Center Quality Metrics

Abstract

Recent advances in stroke treatment created a need for a consensus statement by industry experts detailing elements of quality stroke care. In 2005, the brain attack coalition published recommendations outlining elements constituting the highest level of stroke care, the comprehensive stroke center. Unlike primary level stroke care, comprehensive center recommendations have not resulted in creation of a corresponding national certification process-largely owing to difficulties in establishing quality metrics. The authors proposed 13 comprehensive quality measures and assessed them at a tertiary referral, teaching hospital in Houston, Texas. Proposed metrics were derived from the 2005 brain attack coalition's comprehensive center guidelines. Outcomes measures included morbidity and mortality rates for stroke, cerebral aneurysm, carotid endarerectomy, and stent patients. Process measures included timeliness of brain imaging interpretation, timeliness and consideration of antiplatelet treatment regimes for carotid stent patients, and documentation of National Institutes of Health Stroke Score. Metrics were defined by international classification of disease codes with accompanying inclusion and exclusion criteria. Internal quality was benchmarked against Primary Stroke Center, research literature, and University Health Consortium rates. Baseline data revealed significant opportunities for improvement in the categories of imaging interpretation timeliness and National Institutes of Health Stroke Score documentation. All other measures fell within expected ranges. Assessment of quality outcomes is the basis for disease-specific certification. Institutions that claim comprehensive capabilities must demonstrate high standards of performance on uniform validated quality metrics. The authors demonstrate the feasibility of operationalizing the metrics outlined in Brain Attack Coalition's comprehensive stroke center recommendations.