title: A systematic review and critical appraisal of quality measures for the emergency care of acute ischemic stroke.
abstract: Acute stroke is an important focus of quality improvement efforts. There are many organizations involved in quality measurement for acute stroke, and a complex landscape of quality measures exists. Our objective is to describe and evaluate existing US quality measures for the emergency care of acute ischemic stroke patients in the emergency department (ED) setting. We performed a systematic review of the literature to identify the existing quality measures for the emergency care of acute ischemic stroke. We then convened a panel of experts to appraise how well the measures satisfy the American College of Cardiology/American Heart Association (ACC/AHA) criteria for performance measure development (strength of the underlying evidence, clinical importance, magnitude of the relationship between performance and outcome, and cost-effectiveness). We identified 7 quality measures relevant to the emergency care of acute ischemic stroke that fall into 4 main categories: brain imaging, thrombolytic administration, dysphagia screening, and mortality. Three of the 7 measures met all 4 of the ACC/AHA evaluation criteria: brain imaging within 24 hours, thrombolytic therapy within 3 hours of symptom onset, and thrombolytic therapy within 60 minutes of hospital arrival. Measures not satisfying all evaluation criteria were brain imaging report within 45 minutes, consideration for thrombolytic therapy, dysphagia screening, and mortality rate. There remains room for improvement in the development and use of measures that reflect high-quality emergency care of acute ischemic stroke patients in the United States.
authors.affiliation: Robert Wood Johnson Foundation, Clinical Scholars Program, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI. Electronic address: ksauser@med.umich.edu.
authors.forename: Kori
authors.initials: K
authors.lastname: Sauser
authors.affiliation: Robert Wood Johnson Foundation, Clinical Scholars Program, University of Michigan, Ann Arbor, MI; Department of Neurology, University of Michigan Health System, Ann Arbor, MI; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI.
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.affiliation: Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI.
authors.forename: William G
authors.initials: WG
authors.lastname: Barsan
authors.affiliation: Department of Neurology, University of Michigan Health System, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Levine
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics / Q000592:standards*; D006801:Humans; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards