Cerebrovascular Disease

Clinical Measures

Joint Commission Clinical Measures

2015 - 2018

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 Measure Measure Description 2015a 2016a 2017a 2018a
CSTK-1: NIH Stroke Scale Ischemic 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 arrival. 93.8%
(301/321)
95.2%
(279/293)
98.0%
(292/298)
96.3%
(310/322)
CSTK-2: Modified Rankin Scale measured at 90 days Ischemic 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 person. 83.6%
(97/116)
97.1%
(100/103)
100%
(91/91)
Retired
CSTK 3: Severity -measurement for SAH and ICH SAH 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 arrival. 90.5%
(220/243)
91.4%
(224/245)
93.6%
(205/219)
97.1%
(233/240)
CSTK-4: Procoagulant reversal agent initiation in ICH ICH patients with an INR > 1.4 at hospital arrival who are treated with a procoagulant reversal agent. 100%
(17/17)
100%
(9/9)
91.7%
(11/12)
83.3%
(10/12)
CSTK-5: Hemorrhagic transformation Ischemic stroke patients who develop symptomatic intracranial hemorrhage within 36 hours after treatment with IV t-PA or thrombectomy. NAᵇ 4.5%
(5/110)
2.6%
(3/116)
5.1%
(7/136)
CSTK-6: Nimodipine SAH patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital. 95%
(76/80)
97.9%
(95/97)
97.5%
(79/81)
98.6%
(69/70)
CSTK-8: TICI reperfusion grading score Ischemic stroke patients with a posttreatment reperfusion grade of TICI 2B or higher after thrombectomy. 83.1%
(64/77)
86.8%
(66/76)
80.0%
(64/80)
88.8%
(79/89)
CSTK-9: Arrival to skin puncture Median time from hospital arrival to the time of skin puncture to access the artery for thrombectomy patients. NAᶜ NAᶜ 104.2 minutes 54.2 minutes
CSTK-10: Modified Rankin Scale at 90 days - favorable outcome Patients who received IV t-PA and/or mechanical endovascular reperfusion and have a modified Rankin Scale ? 2 at 90 days. NAᵈ NAᵈ NAᵈ 39.5%
(30/76)
CSTK-11: Timeliness of reperfusion Patients with an ELVO received mechanical endovascular reperfusion within 120 minutes of arrival and have a TICI 2B or higher. NAᵈ NAᵈ NAᵈ 70.7%
(58/82)
CSTK-12: Timeliness of reperfusion Patients with an ELVO received mechanical endovascular reperfusion and a TICI 2B or higher within 60 minute of skin puncture. NAᵈ NAᵈ NAᵈ 60.7%
(54/89)

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

ᵃ Since 2013 Cleveland Clinic has sampled 50% 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%.
ᵇ For 2015 the Joint Commission definition for hemorrhagic transformation (CTSK-5) was in draft. Starting in 2016, CTSK-5 data had an agreed upon definition. This measure reviews negative outcomes in patients treated with IV t-PA and/or endovascular therapy. A lower number means fewer negative outcomes.
ᶜ Measure was new for 2017.
ᵈ Measure was new for 2018.

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 2018

2014 - 2018

Clinical Measure Measure Description GWTG Stroke Performance Award Goal National Average 2018 2014ᵃ 2015ᵃ 2016ᵃ 2017ᵃ 2018ᵃ
STK 1: VTE prophylaxis Ischemic 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 admission. 0.85 0.976 99.6% (484/486) 99.4% (477/480) 99.8% (485/486) 99.5% (379/381) 99.8% (414/415)
STK 2: Antithrombotics at discharge Ischemic stroke patients prescribed antithrombotic therapy at discharge (e.g., warfarin, aspirin, other antiplatelet drug). 0.85 0.995 99.7% (326/327) 100.0% (349/349) 99.7% (290/292) 100% (200/200) 100% (218/218)
STK 3: Anticoagulation for atrial fibrillation/ atrial flutter Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge. 0.85 0.976 94.6%
(53/56)
100.0% (54/54) 98.4%
(62/63)
100%
(41/41)
100%
(36/36)
STK 4: IV rt-PA 2 hour, treat by 3 hour Acute 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 well. 0.85 0.927 100%
(13/13)
100%
(20/20)
95.5%
(21/22)
94.4%
(17/18)
100%
(25/25)
STK 5: Early antithrombotics Ischemic stroke patients who receive antithrombotic therapy by the end of hospital day 2. 0.85 0.977 99.1% (223/225) 96.3% (234/243)) 96.4% (187/194) 96.4% (107/111) 99.2% (128/129)
STK 6: Statin Ischemic stroke patients who are prescribed statin medication at hospital discharge. 0.85 0.983 96.2% (230/239) 97.7% (272/279) 99.3% (271/273) 97.8% (182/186) 100% (205/205)
STK 8: Stroke education Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during their hospital stay addressing stroke. 0.85 0.965 95.1% (195/205) 96.0% (215/224) 93.4% (183/196) 90.6% (154/170) 89.5% (170/190)
STK 10: Rehabilitation considered Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services. 0.85 0.993 97.4% (457/469) 98.1% (464/474) 99.4% (470/473) 98.6% (358/363) 99.5% (395/397)

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

ᵃ Since 2013 Cleveland Clinic has sampled 50% 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. 2018 rates are taken from the GWTG-Joint Commission Primary Stroke Center Reporting Tool, "STK Measure Set" as of February 2019.