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  • Measure Summary
  • NQMC:010134
  • Oct 2015
  • NQF-Endorsed Measure

Stroke: percent of ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services.

Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 4.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2014 Apr. various p.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percent of patients 18 years of age and older with ischemic or hemorrhagic stroke who were assessed for rehabilitation services.

Rationale

Each year about 700,000 people experience a new or recurrent stroke, which is the nation's third leading cause of death. Approximately two thirds of these individuals survive and require rehabilitation. Stroke is a leading cause of serious, long-term disability in the United States, with about 4.4 million stroke survivors alive today. Forty percent of stroke patients are left with moderate functional impairment and 15 to 30 percent with severe disability. More than 60 percent of those who have experienced stroke, serious injury, or a disabling disease have never received rehabilitation. Stroke rehabilitation should begin as soon as the diagnosis of stroke is established and life-threatening problems are under control. Among the high priorities for stroke are to mobilize the patient and encourage resumption of self-care activities as soon as possible. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function.

Evidence for Rationale

Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Primary Health Components

Stroke; rehabilitation services

Denominator Description

Ischemic or hemorrhagic stroke patients (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Ischemic or hemorrhagic stroke patients assessed for or who received rehabilitation services

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
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • Stroke ranks as the number five cause of death in the United States, following diseases of the heart, cancer, and chronic lung-related diseases. Each year, approximately 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent strokes. These numbers equate to one stroke victim every 40 seconds on average. According to 2010 mortality data, one of every 20 deaths in the United States is attributable to stroke. Women have a higher lifetime risk of stroke than men. Lifetime risk of stroke among those 55 to75 years of age was 1 in 5 for women (20% to 21%) and approximately 1 in 6 for men (14% to 17%). Blacks have a risk of first-ever stroke that is almost twice that of whites (American Heart Association [AHA], 2015).
  • Stroke is also a leading cause of long-term disability (Centers for Disease Control and Prevention [CDC], 2009). Data from the National Heart, Lung and Blood Institute (NHLBI) revealed that 50% of ischemic stroke survivors age greater than 65 years had some hemiparesis; 35% experienced depressive symptoms; 30% were unable to ambulate without assistance; 26% were dependent in activities of daily living; 19% had aphasia; and 26% were institutionalized in a nursing home. The mean lifetime cost of ischemic stroke, including inpatient care, rehabilitation, and follow-up as necessary for residual deficits are estimated at $140,048 per person (AHA, 2015).
  • The evidence indicates that patients do better with a well-organized, multidisciplinary approach to post-acute rehabilitation after stroke. The rehabilitation team may consist of a physician, nurse, physical therapist, occupational therapist, kinesiotherapist, speech and language pathologist, psychologist, recreational therapist, patient, and family members/caregivers. If an organized rehabilitation team is not available in the facility, the evidence indicates that patients with moderate or severe symptoms should be offered a referral to a facility with such a service.
  • Stroke rehabilitation should begin during the acute hospitalization, as soon as the diagnosis of stroke is established and life-threatening problems are controlled. The highest priorities of early stroke rehabilitation are to prevent recurrence of stroke, manage comorbidities, and prevent complications related to immobility, dysphagia, and bowel and bladder dysfunction. Rehabilitation services may include: dysphagia treatment and management; speech therapy for communication disorders (i.e., aphasia and dysarthria) and related cognitive impairments; lower-extremity strengthening and gait training; positioning, passive stretching, range-of-motion exercises, and pharmacotherapy for patients with paretic limbs and muscle spasticity; corrective measures (e.g., splinting, serial casting, surgery) for contractures; treatment interventions for post-stroke shoulder pain; treatment for depression and other cognitive and emotional disorders; and, other services.
  • Living with disabilities after a stroke is a lifelong challenge during which people continue to seek and find ways to compensate for or adapt to persisting neurological deficits. For many, the real work of recovery begins after formal rehabilitation when the patient attempts to use newly learned skills without the support of the rehabilitation environment or team (Bates et al., 2005).

Evidence for Additional Information Supporting Need for the Measure

American Heart Association (AHA). Heart disease and stroke statistics - 2015 update. Dallas (TX): American Heart Association (AHA); 2015. 22 p.

Bates B, Choi JY, Duncan PW, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D, Zorowitz R, US Department of Defense, Department of Veterans Affairs. Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: executive summary. Stroke. 2005 Sep;36(9):2049-56. PubMed External Web Site Policy

Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults--United States, 2005. MMWR Morb Mortal Wkly Rep. 2009 May 1;58(16):421-6. PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Accreditation

Certification

Collaborative inter-organizational quality improvement

External oversight/Medicare

External oversight/Other national programs

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

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

Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Safety

Case Finding Period

Discharges October 1 through June 30

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
Discharges with an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Principal Diagnosis Code for ischemic or hemorrhagic stroke (as defined in the appendices of the original measure documentation)

Exclusions

  • Patients less than 18 years of age
  • Patients who have a Length of Stay (LOS) greater than 120 days
  • Patients with Comfort Measures Only (as defined in the Data Dictionary) documented
  • Patients enrolled in clinical trials
  • Patients admitted for Elective Carotid Intervention (as defined in the Data Dictionary)
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Ischemic or hemorrhagic stroke patients assessed for or who received rehabilitation 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

  • STK Initial Patient Population Algorithm Flowchart
  • STK-10: Assessed for Rehabilitation Flowchart

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

Unspecified

Original Title

STK-10: assessed for rehabilitation.

Measure Collection Name

National Hospital Inpatient Quality Measures

Measure Set Name

Stroke

Submitter

The Joint Commission - Health Care Accreditation Organization

Developer

The Joint Commission - Health Care Accreditation Organization

Funding Source(s)

All external funding for measure development has been received and used in full compliance with The Joint Commission's Corporate Sponsorship policies, which are available upon written request to The Joint Commission.

Composition of the Group that Developed the Measure

The composition of the group that developed the measure is available at: http://www.jointcommission.org/assets/1/6/Roster_STK_Maintenance_TAP_web_posting_Jul2012.pdf External Web Site Policy.

Financial Disclosures/Other Potential Conflicts of Interest

Expert panel members have made full disclosure of relevant financial and conflict of interest information in accordance with the Joint Commission's Conflict of Interest policies, copies of which are available upon written request to The Joint Commission.

Endorser

National Quality Forum

NQF Number

0441

Date of Endorsement

2014 Dec 23

Measure Initiative(s)

Hospital Inpatient Quality Reporting Program

Quality Check®

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

This measure is reviewed and updated every 6 months.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 4.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2014 Apr. various p.

Source(s)

Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Measure Availability

Source available from The Joint Commission Web site External Web Site Policy. Information is also available from the QualityNet Web site External Web Site Policy. Check The Joint Commission Web site and QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

NQMC Status

The Joint Commission originally submitted this NQMC measure summary to ECRI Institute on April 30, 2009. This NQMC summary was reviewed accordingly by ECRI Institute on September 9, 2009. The information was verified by the measure developer on November 9, 2009.

The Joint Commission informed NQMC that this measure was updated on April 28, 2010 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on September 3, 2010.

This NQMC summary was retrofitted into the new template on May 18, 2011.

The Joint Commission informed NQMC that this measure was updated on August 13, 2012 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on December 17, 2012.

The Joint Commission informed NQMC that this measure was updated again on August 28, 2013 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on January 30, 2014.

The Joint Commission informed NQMC that this measure was updated on March 23, 2015 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on April 10, 2015.

The Joint Commission informed NQMC that this measure was updated on July 22, 2015 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on August 4, 2015.

This NQMC summary was edited by ECRI Institute on November 16, 2015.

Copyright Statement

The Specifications Manual for National Hospital Inpatient Quality Measures [Version 5.0b, October, 2015] is the collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare & Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Inpatient Quality Measures must update their software and associated documentation based on the published manual production timelines.

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