Quality Improvement Guidelines
Links to articles relevant to Stroke QI
- Schwamm L., Fonarow G., Reeves M., Pan W., Frankel M., Smith E., Ellrodt G., Cannon C., Liang L., Peterson E., LaBresh K. Get With The Guidelines-Stroke is Associated with Sustained Improvement in Care for Patients Hospitalized with Acute Stroke or TIA. Circulation (December 2008)
- Reeves M., Fonarow G., Zhao X., Smith E., Schwamm L. Quality of Care in Women With Ischemic Stroke in the GWTG Program. Stroke (February 2009)
- LaBresh K.A., Reeves M.J., Frankel M.R., Albright D., Schwamm L.H. Hospital Treatment of Patients with Ischemic Stroke or Transient Ischemic Attack with Get With The Guidelines. Arch Intern Med (2008;168(4):411-417) Read article (February 2008)
- Reeves M., Smith E., Yu Y., Schwamm L. Off-Hour Admission and In-hospital Stroke Case Fatality in the Get With The Guidelines-Stroke Program. Stroke. DOI: 10.1161/STROKEAHA.108.519355. Read article (November 2008)
- American Heart Association Media News Releases
8 NQS/CMS Measures
The 8 measures that National Quality Forum (NQF) recommended and that Centers for Medicare & Medicaid Services (CMS) has adopted effective 10/01/09 for Stroke. Chart information gathered from the NQF website 
World Stroke Organization Clinical Practice Guidelines
Development Handbook for Stroke Care
The clinical practice guideline development handbook for stroke care has been developed by the WSO Stroke Guideline Sub-Committee from January to June 2009.
This handbook has been developed to provide a basic guide for healthcare professionals who wish to develop or adapt clinical guidelines for stroke care across any point in the continuum of care.
This handbook is particularly intended for healthcare professionals who manage stroke patients in developing countries or where healthcare resources are scarce. It aims to promote the use of evidence-informed care through locally developed or adapted guidelines without compromising the quality of the resource.
UPDATE: National Reporting of Stroke Measures
Purpose
The purpose of this update is to inform NC Stroke Care Collaborative (NCSCC) hospitals’ stroke staff [and ENCSN QI workgroup members] of the current issues around national reporting of stroke measures. NC Department of Public Health (DPH) is not the authority on these issues. Our goal is to notify you of the developments of which we are aware. We encourage you to discuss these topics with your Quality Improvement/Performance Improvement Departments. The information below summarizes recent actions by The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) related to stroke performance measures.
Background
In 2008, the National Quality Forum (NQF) endorsed 8 of the 10 stroke consensus measures listed below. The dysphagia screening and smoking cessation measures were not endorsed.
Measure ID # Measure Short Name
STK-1 Venous Thromboembolism (VTE) Prophylaxis
STK-2 Discharged on Antithrombotic Therapy
STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter
STK-4 Thrombolytic Therapy
STK-5 Antithrombotic Therapy By End of Hospital Day 2
STK-6 Discharged on Statin Medication
STK-8 Stroke Education
STK-10 Assessed for Rehabilitation
TJC
Effective Oct. 1, 2009, TJC will include the 8 NQF-endorsed stroke measures as a new measure set for core measure reporting for accredited hospitals. For more information about issues related to TJC, go to these sites:
- Specifications Manual (starting October 1, 2009)
- TJC Performance Measurement
- TJC Stroke Core Measures
- Outcome Science is developing the capability for stroke measure submission directly to TJC from the Patient Management Tool for an annual fee of $2,887. Joint Commission PSC hospitals will not be charged the fee. All GWTG-Stroke hospitals were contacted via email. For details, contact Outcome at (888) 526-6700.
- We encourage you to discuss this with your Quality Improvement/Performance Improvement departments or those responsible for TJC core measures at your institution.
CMS
- CMS publishes the Inpatient Prospective Payment System (IPPS) annually which outlines the reportable performance measures that impact hospital reimbursement rates for Medicare patients under the National Hospital Inpatient Quality Measures.
- On April 30, 2009, the FY2010 IPPS proposed rule was published. The document is available online
- The IPPS includes a “structural measure” proposing to require hospitals to report whether or not they are participating in a stroke registry, and if so, the name of the registry. This would go into effect October 2009.
- The IPPS rule proposed that the 8 NQF-endorsed stroke measures NOT be collected until October 2010.
- CMS is considering submission of the data via existing registries (e.g.: the NCSCC or GWTG-Stroke) as well as submission via electronic medical records.