Some Quality Measures Used in Emergency Care of Acute Ischemic Stroke Not Well-Validated

VBCN - July 2014 Volume 1, No 2

A systematic review of existing quality measures for the emergency care of acute ischemic stroke has revealed that only 3 measures meet all of the American College of Cardiology (ACC)/American Heart Association (AHA) evaluation criteria (Sauser K, et al. Ann Emerg Med. 2014 Mar 7 [Epub ahead of print]).

“It is…important that the focus be on processes strongly supported by the evidence. For example, the magnitude of the relationship between patient outcomes and imaging within 45 minutes is not fully established; thus, if hospitals are to reengineer door-to-imaging systems to improve thrombolytic delivery, these relationships ought to be better quantified,” noted Kori L. Sauser, MD, MSc, Clinical Lecturer, Emergency Medicine, University of Michigan, Ann Arbor, and her colleagues.

Of the 976 articles reviewed, 4 articles were included in the final analysis; most of the others were not conducted in the United States. The team also found 6 groups that used the Internet to disseminate information on quality measure programs for the emergency care of acute ischemic stroke.

In total, the articles and websites included 7 quality measures: 2 related to brain imaging, 3 to thrombolytic therapy, 1 to dysphagia screening, and 1 related to mortality.

A panel of 5 experts in emergency medicine, stroke neurology, internal medicine, stroke epidemiology, and stroke quality improvement evaluated whether these measures met each of the 4 ACC/AHA criteria.

The 3 measures that did meet the criteria are:
  • Brain imaging within 24 hours of arrival at the emergency department
  • Thrombolytic therapy within 3 hours of symptom onset
  • Thrombolytic therapy within 60 minutes of arrival at the emergency department.

The other 4 measures that are used by many experts—a brain-imaging report generated within 45 minutes of arrival at the emergency department, consideration for antithrombolytic therapy, dysphagia screening, and mortality rate—did not meet all of the ACC/AHA criteria.

“This highlights the challenge of developing quality measures for the emergency care setting....Future quality measures for emergency care of ischemic stroke must have a strong evidence base and be tied to clinically meaningful outcomes. Possibilities include out-of-hospital measures targeting emergency medical services coordination or blood pressure control,” the group concluded.

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