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  • Measure Summary
  • NQMC:009990
  • Mar 2015

Stroke: percentage of ischemic stroke patients for whom an initial National Institutes of Health Stroke Scale (NIHSS) score is performed prior to any acute recanalization therapy in patients undergoing recanalization therapy and documented in the medical record, OR documented within 12 hours of arrival at the hospital ED for patients who do not undergo recanalization therapy.

The Joint Commission. Disease-specific care certification program. Comprehensive stroke: performance measurement implementation guide. Oakbrook Terrace (IL): The Joint Commission; 2015 Mar. 278 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

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

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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 ischemic stroke patients for whom an initial National Institutes of Health Stroke Scale (NIHSS) score is performed prior to any acute recanalization therapy (i.e., intravenous [IV] thrombolytic [t-PA] therapy, or intra-arterial [IA] thrombolytic [t-PA] therapy, or mechanical endovascular reperfusion therapy) in patients undergoing recanalization therapy and documented in the medical record, OR documented within 12 hours of arrival at the hospital emergency department for patients who do not undergo recanalization therapy.

Rationale

A neurological examination of all patients presenting to the hospital emergency department with warning signs and symptoms of stroke should be a top priority and performed in a timely fashion. Use of a standardized stroke scale or scoring tool ensures that the major components of the neurological examination are evaluated. Clinical practice guidelines from the American Heart Association/American Stroke Association recommend the National Institutes of Health Stroke Scale (NIHSS) as the preferred scoring tool for this purpose. Scores obtained aid in the initial diagnosis of the patient, facilitate communication among healthcare professionals, and identify patient eligibility for various interventions and the potential for complications.

Evidence for Rationale

Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF, American Heart Association, American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interd[TRUNC]. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007 May;38(5):1655-711. PubMed External Web Site Policy

Côté R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke. 1986 Jul-Aug;17(4):731-7. PubMed External Web Site Policy

Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke. 1997 Feb;28(2):307-10. PubMed External Web Site Policy

Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947. PubMed External Web Site Policy

Kothari RU, Brott T, Broderick JP, Hamilton CA. Emergency physicians. Accuracy in the diagnosis of stroke. Stroke. 1995 Dec;26(12):2238-41. PubMed External Web Site Policy

Leifer D, Bravata DM, Connors JJ, Hinchey JA, Jauch EC, Johnston SC, Latchaw R, Likosky W, Ogilvy C, Qureshi AI, Summers D, Sung GY, Williams LS, Zorowitz R, American Heart Association Special Writing Group of the Stroke Council, Atherosclerotic Peripheral Vascular Disease Working Group, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Nursing. Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Mar;42(3):849-77. PubMed External Web Site Policy

Morgenstern LB, Lisabeth LD, Mecozzi AC, Smith MA, Longwell PJ, McFarling DA, Risser JM. A population-based study of acute stroke and TIA diagnosis. Neurology. 2004 Mar 23;62(6):895-900. PubMed External Web Site Policy

The Joint Commission. Disease-specific care certification program. Comprehensive stroke: performance measurement implementation guide. Oakbrook Terrace (IL): The Joint Commission; 2015 Mar. 278 p.

Primary Health Components

Ischemic stroke; National Institutes of Health Stroke Scale (NIHSS); acute recanalization therapy; intravenous (IV) thrombolytic (t-PA) therapy; intra-arterial (IA) thrombolytic (t-PA) therapy; mechanical endovascular reperfusion therapy

Denominator Description

Ischemic stroke patients who arrive at the hospital emergency department (ED) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Ischemic stroke patients for whom a National Institutes of Health Stroke Scale (NIHSS) score is performed prior to any acute recanalization therapy in patients undergoing recanalization therapy and documented in the medical record, OR documented within 12 hours of hospital arrival for patients who do not undergo recanalization therapy (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
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Certification

Collaborative inter-organizational quality improvement

Internal quality improvement

Measurement Setting

Emergency Department

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

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

Timeliness

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
Discharges with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code for ischemic 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 greater than 120 days
  • Patients with Comfort Measures Only (as defined in the Data Elements) documented on the day of or day after hospital arrival
  • Patients admitted for Elective Carotid Intervention (as defined in the Data Elements)
  • Patients who do not undergo recanalization therapy and are discharged within 12 hours of arrival at this hospital

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions

  • Patients with documented thrombolytic (intravenous [IV] or intra-arterial [IA] thrombolytic [t-PA]) therapy (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] Principal or Other Procedure Codes as defined in the appendices of the original measure documentation), OR
  • Patients with documented mechanical endovascular reperfusion therapy (ICD-9-CM Principal or Other Procedure Codes as defined in the appendices of the original measure documentation)

Exclusions
None

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

  • The National Institutes of Health Stroke Scale (NIHSS)
  • Comprehensive Stroke (CSTK) Initial Patient Population Algorithm Flowchart
  • CSTK-01: National Institutes of Health Stroke Scale (NIHSS Score Performed for Ischemic Stroke Patients) 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

Does not apply to this measure

Standard of Comparison

Internal time comparison

Original Title

CSTK-01: National Institutes of Health Stroke Scale (NIHSS score performed for ischemic stroke patients).

Measure Collection Name

Advanced Certification in Disease-specific Care Measures

Measure Set Name

Comprehensive Stroke Standardized Performance Measures

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

Unspecified

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 The Joint Commission.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Mar

Measure Maintenance

This measure is reviewed and updated by the developing organization every 6 months.

Date of Next Anticipated Revision

2015 Jul

Measure Status

This is the current release of the measure.

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

Source(s)

The Joint Commission. Disease-specific care certification program. Comprehensive stroke: performance measurement implementation guide. Oakbrook Terrace (IL): The Joint Commission; 2015 Mar. 278 p.

Measure Availability

Source available from The Joint Commission Web site External Web Site Policy.

For more information, contact The Joint Commission at One Renaissance Blvd., Oakbrook Terrace, IL 60181; Phone: 630-792-5800; Fax: 630-792-5005; Web site: www.jointcommission.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 19, 2015. The information was verified by the measure developer on June 22, 2015.

The information was reaffirmed by the measure developer on April 6, 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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