Neurological Institute Outcomes
Cerebrovascular Disease
Clinical Measures
Joint Commission Clinical Measures
2019 – 2022
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 | 2019ᵃ | 2020ᵃ | 2021ᵃ | 2022ᵃ |
|---|---|---|---|---|---|
| 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 | 95.9% (303/316) | 97.7% (295/302) | 97.7% (290/300) | 97.2% (281/289) |
| 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 | 91.2% (197/216) | 96.4% (186/193) | 97.5% (192/197) | 98.5% (196/199) |
| 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% (6/6) | 100% (9/9) | 88.9% (8/9) | 100% (7/7) |
| CSTK-5: Hemorrhagic transformation | Ischemic stroke patients who develop symptomatic intracranial hemorrhage within 36 hours after treatment with IV t-PA or thrombectomy | 5.4% (7/129) | 6% (7/117) | 4.5% (5/112) | 5.8% (6/103) |
| CSTK-6: Nimodipine | SAH patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital | 100% (64/64) | 97.4% (76/78) | 98.8% (83/84) | 100% (97/97) |
| CSTK-8: TICI reperfusion grading score | Ischemic stroke patients with a posttreatment reperfusion grade of TICI 2B or higher after thrombectomy | 85.6% (77/90) | 85.1% (74/87) | 90.6% (77/85) | 80.3% (57/71) |
| CSTK-9: Arrival to skin puncture | Median time from hospital arrival to the time of skin puncture to access the artery for thrombectomy patients | 32 min | 19.5 min | 22 min | 15 min |
| 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 | 43.9% (36/82) | 37.9% (36/95) | 39.6% (36/91) | 44.6% (33/74) |
| CSTK-11: Timeliness of reperfusion | Patients with an ELVO who received mechanical endovascular reperfusion within 120 min of arrival and have a TICI 2B or higher | 78.5% (62/79) | 77.2% (61/79) | 83.6% (56/67) | 72.2% (39/54) |
| CSTK-12: Timeliness of reperfusion | Patients with an ELVO who received mechanical endovascular reperfusion and have a TICI 2B or higher within 60 min of skin puncture | 75.3% (67/89) | 66.3% (55/83) | 76.2% (64/84) | 58.2% (39/67) |
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
2019 – 2022
| Clinical Measure | Measure Description | GWTG Stroke Performance Award Goal | National Median 2021 | 2019ᵃ | 2020ᵃ | 2021ᵃ | 2022ᵃ |
|---|---|---|---|---|---|---|---|
| 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 | 85% | 97.3% | 98.8% (403/408) | 99.8% (449/450) | 99.3% (446/449) | 98.8% (416/421) |
| STK 2: Antithrombotics at discharge | Ischemic stroke patients prescribed antithrombotic therapy at discharge (eg, warfarin, aspirin, other antiplatelet drug) | 85% | 99.5% | 99.5% (215/216) | 99.6% (245/246) | 100% (237/237) | 99.6% (224/225) |
| STK 3: Anticoagulation for atrial fibrillation/atrial flutter | Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge | 85% | 97.7% | 100% (35/35) | 100% (44/44) | 100% (41/41) | 98.1% (53/54) |
| STK 4: IV t-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 | 85% | 91.3% | 100% (26/26) | 100% (20/20) | 100% (23/23) | 100% (22/22) |
| STK 5: Early antithrombotics | Ischemic stroke patients who receive antithrombotic therapy by the end of hospital day 2 | 85% | 97.5% | 99.3% (141/142) | 98.9% (177/179) | 98.6% (144/146) | 96.4% (159/165) |
| STK 6: Statin | Ischemic stroke patients who are prescribed statin medication at hospital discharge | 85% | 98.5% | 99.5% (198/199) | 99.2% (236/238) | 99.1% (217/219) | 99.5% (210/211) |
| STK 8: Stroke education | Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during their hospital stay addressing stroke | 85% | 96.2% | 91.1% (163/179) | 95.9% (211/220) | 95.7% (200/209) | 96.4% (190/197) |
| STK 10: Rehabilitation considered | Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services | 85% | 99.3% | 98.7% (385/390) | 98.3% (408/415) | 99.5% (423/425) | 99.5% (396/398) |
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.
