AHA/ASA Issues Statement on Metrics for Quality of Care in Comprehensive Stroke Centers

January 13, 2011—The American Heart Association/American Stroke Association (AHA/ASA) announced the publication of a statement for health care professionals recommending metrics for measuring and improving quality of care in comprehensive stroke centers (CSCs). The document by Dana Leifer, MD, et al was made available online ahead of print in Stroke.

According to the AHA/ASA, the metrics are being proposed to assist in the standardized designation of CSCs. These centers would be expected to monitor new diagnostic and treatment metrics, in addition to the standard metrics now required for primary stroke centers (PSCs) designated by The Joint Commission. CSCs would provide a highly specialized and advanced level of care, including neurosurgery and interventional neuroradiologic procedures for patients with ischemic strokes and hemorrhagic strokes.

The new recommendations are based on experience with previous quality improvement initiatives, such as the AHA/ASA's Get With The Guidelines program.

Dr. Leifer noted that numerous studies have now documented that such initiatives improve patient care and outcomes when metrics are used to monitor the quality of care. He said improving how quickly patients with ischemic and hemorrhagic strokes are diagnosed and treated is a cornerstone of the recommendations. Some of the standards include:

• Specifically tracking the percentage of ischemic stroke patients identified as eligible for tissue plasminogen activator and appropriately treated within a 60-minute door-to-needle time;
• Tracking the time from hospitalization to treatment to repair blood vessels for patients with a ruptured aneurysm; and
• Performing 90-day follow-up of ischemic stroke patients to assess their outcome after acute interventions, including treatment with tissue plasminogen activator.

"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," commented Dr. Leifer. "Initially, CSCs may have the option to track only some of the other metrics, just as PSCs were only required to track a few measures at first. 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."

The statement writing committee devised the measures after extensively reviewing published papers on the most effective treatments and outcomes among severe stroke patients. Their efforts date to 2005, when the AHA/ASA, as part of a collaborative effort called the Brain Attack Coalition, recommended establishing CSCs. Five years earlier, the coalition issued recommendations for PSCs, and more than 800 are now certified nationwide.

AHA President Ralph L. Sacco, MD, said that although some hospitals are self-proclaimed CSCs, there is no standard certification program in place such as that for PSCs. Such a program that consistently holds providers to these new measures could help reduce stroke death and disability.

The AHA issued a presidential advisory outlining the need for a comprehensive hospital certification program with policies and evidence-based criteria for cardiovascular disease and stroke care. The advisory was published on December 4, 2010, in Circulation (2010;122:2459–2469).

"The AHA's 2020 goal is to improve the cardiovascular health of all Americans by 20%, as well as to continue to reduce deaths by cardiac diseases and stroke by 20%," Dr. Sacco said. "Initiatives such as primary and now CSC certification will greatly help us reach our 2020 goal."