Development of performance measures for acute ischemic stroke

Background and Purpose-The purpose of the present study was to develop and rate performance measures for hospital-based acute ischemic stroke. Methods-A national multidisciplinary panel of 16 individuals (2 stroke spec ialists, 2 general neurologists, 2 internists, 2 neuroscience nurses, 2 str oke advocacy organization representatives, 1 stroke rehabilitationist, 1 fa mily practitioner, 1 emergency room physician, 1 neuroradiologist, 1 manage d care organization director, and 1 hospital association representative) fr om 10 medical societies or lay organizations assisted in the development of 44 potential stroke performance measures. We developed evidence summaries for each of the performance measures and graded the level of evidence assoc iated with each measure. The panel received a summary of the literature per taining to each measure and rated the measures by use of a modified Delphi approach for 6 dimensions of quality, including validity of evidence, feasi bility, impact on outcomes, room for improvement, plausibility, and an over all rating (little reason to do, could do, should do, and must do). Results-Highly rated and agreed on performance measures for the overall rat ing include warfarin in atrial fibrillation, antithrombotics on hospital di scharge, carotid imaging in appropriate patients, and use of stroke units. Additional measures notable for high agreement were heparins for deep-vein thrombosis prophylaxis and use of a stroke protocol. Panelists rated time-r elated thrombolytic measures such as head CT within 25 minutes highly on th e room for improvement dimension but low on the overall dimension. Neurolog ists tended to rate measures lower than did nonneurologists (P < 0.01) for all 9 measures pertaining to thrombolytic management. Conclusions-Highly rated and agreed on performance measures exist in all do mains of hospital-based stroke care.