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  • Measure Summary
  • NQMC:002909
  • Sep 2010

Stroke and stroke rehabilitation: percentage of patients aged 18 years and older with the diagnosis of ischemic stroke or intracranial hemorrhage who underwent a dysphagia screening process before taking any foods, fluids or medication by mouth.

American Academy of Neurology, American College of Radiology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Stroke and stroke rehabilitation physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 26 p. [8 references]

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 18 years and older with the diagnosis of ischemic stroke or intracranial hemorrhage who underwent a dysphagia screening process before taking any foods, fluids, or medication by mouth.

To promote a comprehensive approach to performance improvement, the Stroke and Stroke Rehabilitation Measurement Set is intended for use in its entirety when measuring clinical quality in the care of eligible patients. Full implementation of this measurement set for patients with a diagnosis of ischemic stroke or transient ischemic attack (TIA) should always include the Physician Consortium for Performance Improvement® measure, Radiology: Stenosis Measurement in Carotid Imaging Reports.

Rationale

All patients should have their swallowing evaluated prior to receiving food, fluids or oral medications to help prevent aspiration. The evaluation should be performed with a validated or hospital-approved dysphagia screening tool; a routine cranial nerve examination is not sufficient.*

*The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

Recommend that all patients have their swallow screened before initiating oral intake of fluids or food, utilizing a simple valid bedside testing protocol. (Veterans Administration/Department of Defense [VA/DoD])

Evidence for Rationale

American Academy of Neurology, American College of Radiology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Stroke and stroke rehabilitation physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 26 p. [8 references]

Veterans Health Administration, Department of Defense. VA/DoD clinical practice guideline for the management of stroke rehabilitation in the primary care setting. Washington (DC): Department of Veteran Affairs; 2003 Feb. Various p. [331 references]

Primary Health Components

Ischemic stroke; intracranial hemorrhage; dysphagia screening

Denominator Description

All patients aged 18 years and older with the diagnosis of ischemic stroke or intracranial hemorrhage who receive any foods, fluids or medication by mouth (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who underwent a dysphagia screening process before taking any foods, fluids or medication by mouth (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Professional certification

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients aged 18 years and older with the diagnosis of ischemic stroke or intracranial hemorrhage who receive any foods, fluids or medication by mouth

Exclusions
Documentation of medical reason(s) for not screening for dysphagia before taking any foods, fluids or medication by mouth

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who underwent a dysphagia screening* process before taking any foods, fluids or medication by mouth

*Dysphagia Screening: Use of a tested and validated dysphagia screening tool (e.g., Burke dysphagia screening test, 3 oz. water swallow test, Mann assessment of swallowing ability [MASA], standardized bedside swallowing assessment [SSA]) OR a dysphagia screening tool approved by the hospital's speech/language pathology (SLP) services.

Exclusions
None

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure #5: screening for dysphagia.

Measure Collection Name

Stroke and Stroke Rehabilitation Physician Performance Measurement Set

Submitter

American Academy of Neurology - Medical Specialty Society

Developer

American Academy of Neurology - Medical Specialty Society

American College of Radiology - Medical Specialty Society

National Committee for Quality Assurance - Health Care Accreditation Organization

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Joseph Drozda, Jr., MD (Co-Chair); Robert Holloway, MD, MPH (Co-Chair); David Seidenwurm, MD (Co-Chair); Chris Alexander, III, MD, FACP; John Barr, MD; Oscar Benavente, MD, FRCPC; Christopher Bever, Jr., MD, MBA; Thomas Bleck, MD FCCM; Ronald Gabel, MD; Judith Hinchey, MD; Irene Katzan, MD; Rahul K. Khare, MD; Michael Lev, MD; John McMahon, MD; Mark Morasch, MD, FACS; Suresh Mukherji, MD; Konrad C. Nau, MD; Sam J. W. Romeo, MD, MBA; Eric Russell, MD, FACR; Marilyn Rymer, MD; Ajay Sharma, MD; John Schneider, MD, PhD; Timothy Shephard, PhD; Michael A. Sloan, MD, MS; William D. Smucker, MD, CMD; Patrick Turski, MD, FACR; Linda Williams, MD; Richard Zorowitz, MD

Sarah Tonn, MPH, American Academy of Neurology

Sandra H. Bjork, RN, JD, American College of Radiology

Penelope Solis, JD, American Heart Association/American Stroke Association

Andrea Gelzer, MD, MS, FACP, Health Plan Representative

Mark Antman, DDS, MBA, American Medical Association; Karen S. Kmetik, PhD, American Medical Association; Beth Tapper, MA, American Medical Association; Samantha Tierney, MPH, American Medical Association

Rebecca A. Kresowik, Facilitator; Timothy F. Kresowik, MD, Facilitator

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Adaptation

This measure was harmonized to the extent possible with hospital level measures for stroke developed by The Joint Commission.

Date of Most Current Version in NQMC

2010 Sep

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

American Academy of Neurology, American College of Radiology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Stroke and stroke rehabilitation physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 26 p. [8 references]

Measure Availability

Source not available electronically.

For more information, contact the American Academy of Neurology (AAN) at 201 Chicago Avenue, Minneapolis, MN 55415; Phone: 800-879-1960; Fax: 612-454-2746; Web site: www.aan.com External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on September 13, 2007. The information was verified by the measure developer on October 26, 2007.

This NQMC summary was edited by ECRI Institute on September 28, 2009.

This NQMC summary was retrofitted into the new template on June 10, 2011.

This NQMC summary was edited by ECRI Institute on April 27, 2012.

The information was reaffirmed by the measure developer on April 15, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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