Cerebrovascular Disease

Clinical Measures

Joint Commission Clinical Measures

2018 – 2021

Comprehensive Core Stroke Measures were developed for the management of both ischemic and hemorrhagic stroke patients in hospitals equipped with clinical expertise, infrastructure, and specialized neurointerventional and imaging services needed to provide a higher level of stroke care.

Joint Commission Clinical MeasureMeasure Description2018ᵃ2019ᵃ2020ᵃ2021ᵃ
CSTK-1: NIH Stroke ScaleIschemic stroke patients for whom an initial NIH Stroke Scale score is performed prior to any acute recanalization therapy or within 12 hours of emergency department arrival96.3%
(310/322)
95.9% (303/316)97.7% (295/302)97.7% (290/300)
CSTK-2: Modified Rankin Scale measured at 90 daysIschemic stroke patients treated with IV t-PA or who undergo thrombectomy for whom a 90-day modified Rankin Scale is obtained via telephone or in personRetiredRetiredRetiredRetired
CSTK-3: Severity measurement for SAH and ICHSAH and ICH patients for whom a severity measurement (Hunt and Hess or ICH Score) is performed prior to surgical intervention or within 6 hours of emergency department arrival97.1%
(233/240)
91.2% (197/216)96.4% (186/193)97.5% (192/197)
CSTK-4: Procoagulant reversal agent initiation in ICHICH patients with an INR > 1.4 at hospital arrival who are treated with a procoagulant reversal agent83.3%
(10/12)
100% (6/6)100% (9/9)88.9% (8/9)
CSTK-5: Hemorrhagic transformationIschemic stroke patients who develop symptomatic intracranial hemorrhage within 36 hours after treatment with IV t-PA or thrombectomy5.1%
(7/136)
5.4% (7/129)6% (7/117)4.5% (5/112)
CSTK-6: NimodipineSAH patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital98.6%
(69/70)
100% (64/64)97.4% (76/78)98.8% (83/84)
CSTK-8: TICI reperfusion grading scoreIschemic stroke patients with a posttreatment reperfusion grade of TICI 2B or higher after thrombectomy88.8%
(79/89)
85.6% (77/90)85.1% (74/87)90.6% (77/85)
CSTK-9: Arrival to skin punctureMedian time from hospital arrival to the time of skin puncture to access the artery for thrombectomy patients38 min32 min19.5 min22 min
CSTK-10: Modified Rankin Scale at 90 days – favorable outcomePatients who received IV t-PA and/or mechanical endovascular reperfusion and have a modified Rankin Scale ≤ 2 at 90 days39.5%
(30/76)
43.9% (36/82)37.9% (36/95)39.6% (36/91)
CSTK-11: Timeliness of reperfusionPatients with an ELVO who received mechanical endovascular reperfusion within 120 min of arrival and have a TICI 2B or higher70.7%
(58/82)
78.5% (62/79)77.2% (61/79)83.6% (56/67)
CSTK-12: Timeliness of reperfusionPatients with an ELVO who received mechanical endovascular reperfusion and have a TICI 2B or higher within 60 min of skin puncture60.7%
(54/89)
75.3% (67/89)66.3% (55/83)76.2% (64/84)

CSTK = Comprehensive Stroke measure set, ELVO = emergent large vessel occlusion, ICH = intracerebral hemorrhage, INR = international normalized ratio, SAH = subarachnoid hemorrhage, TICI = thrombolysis in cerebral ischemia reperfusion grade, t-PA = tissue plasminogen activator

ᵃSince 2013, Cleveland Clinic has sampled 50% of its stroke population for abstraction (the Joint Commission standard is a 30% sample of all charts). Because the Ischemic and Hemorrhagic Stroke populations are separated out for sampling, the Hemorrhagic Stroke population is abstracted at almost 100%.

At this time there are no benchmarks or National Comparisons for CSTK measures. Cleveland Clinic's goal is to provide the best evidence-based care to each patient. Each CSTK is reviewed monthly for any opportunities for improvement.

Get With The Guidelines Clinical Measure

2017 – 2021

Clinical MeasureMeasure DescriptionGWTG Stroke Performance Award GoalNational Average 20212017ᵃ2018ᵃ2019ᵃ2020ᵃ2021ᵃ
STK 1: VTE prophylaxisIschemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission85%96%99.5% (379/381)99.8% (414/415)98.8% (403/408)99.8% (449/450)99.3% (446/449)
STK 2: Antithrombotics at dischargeIschemic stroke patients prescribed antithrombotic therapy at discharge (eg, warfarin, aspirin, other antiplatelet drug)85%99.5%100% (200/200)100% (218/218)99.5% (215/216)99.6% (245/246)100% (237/237)
STK 3: Anticoagulation for atrial fibrillation/atrial flutterIschemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge85%98%100%
(41/41)
100%
(36/36)
100% (35/35)100% (44/44)100% (41/41)
STK 4: IV t-PA 2 hour, treat by 3 hourAcute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well85%93.5%94.4%
(17/18)
100%
(25/25)
100% (26/26)100% (20/20)100% (23/23)
STK 5: Early antithromboticsIschemic stroke patients who receive antithrombotic therapy by the end of hospital day 285%97.4%96.4% (107/111)99.2% (128/129)99.3% (141/142)98.9% (177/179)98.6% (144/146)
STK 6: StatinIschemic stroke patients who are prescribed statin medication at hospital discharge85%98.7%97.8% (182/186)100% (205/205)99.5% (198/199)99.2% (236/238)99.1% (217/219)
STK 8: Stroke educationIschemic or hemorrhagic stroke patients or their caregivers who were given educational materials during their hospital stay addressing stroke85%95.4%90.6% (154/170)89.5% (170/190)91.1% (163/179)95.9% (211/220)95.7% (200/209)
STK 10: Rehabilitation consideredIschemic or hemorrhagic stroke patients who were assessed for rehabilitation services85%99.4%98.6% (358/363)99.5% (395/397)98.7% (385/390)98.3% (408/415)99.5% (423/425)

GWTG = Get With The Guidelines, STK = stroke measure set, t-PA = tissue plasminogen activator, VTE = venous thromboembolism

ᵃSince 2013, Cleveland Clinic has sampled 50% of its stroke population for abstraction (the Joint Commission standard is a 30% sample of all charts). Because the Ischemic and Hemorrhagic Stroke populations are separated out for sampling, the Hemorrhagic Stroke population is abstracted at almost 100%.

Get With The Guidelines® (GWTG) is the premier hospital-based quality improvement program for the American Heart Association and the American Stroke Association, empowering healthcare provider teams to consistently treat stroke patients using current evidence-based guidelines. Cleveland Clinic uses the GWTG aggregate comparative data for internal quality improvement.