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20-01-2011 | Stroke | Article

AHA/ASA propose quality measures for stroke centers


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MedWire News: The American Heart Association (AHA) and American Stroke Association (ASA) have published a raft of measures to guide and monitor the quality of treatment in Comprehensive Stroke Centers (CSCs).

Most patients can be treated at Primary Stroke Centers (PSC) and the establishment of these is associated with proven improvements in stroke care, says their statement.

Some US states are now establishing CSCs, which can offer all current stroke treatments and preventive therapies. The new measures - 26 in all - are intended to aid the development of CSCs. They are published in the journal Stroke.

"Some of the metrics have stronger evidence supporting them or have greater clinical significance, and we designated these as core measures that CSCs should all monitor," said lead author Dana Leifer (Weill Cornell Medical College, New York, USA).

Twelve measures are core measures. They include the percentage of patients with a documented National Institutes of Health Stroke Scale score and the median time to patients undergoing imaging.

Thrombolysis-related measures include the percentage of eligible patients who receive the treatment within the appropriate time window, the proportion of these who start treatment within an hour of arrival, and the percentage who have a documented 90-day modified Rankin Scale score.

CSCs are also advised to document the percentage of patients who suffer symptomatic intracranial hemorrhage after thrombolysis or endovascular interventions.

Several core measures relate to patients with hemorrhagic stroke, including the percentage with documented initial severity measures, the percentage who started treatment with nimodipine, the median time to intervention for a ruptured aneurysm, and also the time to reversal of international normalized ratios in patients with warfarin-associated hemorrhage.

Other, non-core measures relate to hospital transfers, rehabilitative therapies, interventions for atherosclerotic disease, and enrollment of patients into clinical trials.

"Initially, CSCs may have the option to track only some of the other metrics, just as Primary Stroke Centers were only required to track a few measures at first," said Leifer.

"But by using our metrics as part of quality improvement efforts, over time hospitals should be able to improve the quality of the care that they give and improve patient outcomes."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid