KCE_181S_Full_data_ extraction sheet_7_1

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					QI                             Stroke patient type           Phase of intervention   Definition                                                                            Denominator                                               Numerator                                               Performance goal                                     Origin                                                       Country                               Evidence base                                                                                             Grade of recommendationDatabase                     Used for

Hyperacute care (first 24 h)


                               All                           Hyperacute              Assessment of the level of consciousness



                               All                           Hyperacute              Assessment of eye movement
                                                                                                                                                                                                                                                                                                                                                                                                                                                     - 1 RCT: Evans A, Perez I, Harraf F, Melbourn A, Steadman J, Donaldson N, Kalra L. Can
                                                                                                                                                                                                                                                                                                                                                                                                                                                     differences in management processes e
                               All                           Hyperacute              Cognitive/mental test (if the patient is alert)                                                                                                                                                                                                              Systematic review of process indicators: including early
1. Initial neurological
                                                                                                                                                                                                                                                                                                                                                  rehabilitation interventions used to measure quality of
assessment by                                                                                                                                                                                                                                                                                                                                                                                                  Various countries                                                                                                                                         B
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
medical/paramedics
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                               All                           Hyperacute              Visual field testing (if the patient is alert)



                               All                           Hyperacute              Assessment of visual inattention (if the patient is alert)



                               All                           Hyperacute              Sensory testing (if the patient is alert)



2. Time to hospital            All                           Acute                   Proportion of acute ischemic stroke patients who arrive at hospital within 3.5        N/A                                                       Mean/median of LSN time to ED presentation for all                                                           Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice
                                                                                                                                                                                                                                                                                                                                                  Update 2010. CSS Information & Evaluation Working                                                  - Expert opinion: Consensus Review Panel Held December 2009, Canada                                                 D           Recommendation for Stroke
                                                                                     hours of stroke symptom onset                                                                                                                   stroke/TIA patients
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care
                                                                                                                                                                           Total number of stroke patients admitted to               Number of stroke patients who arrive in an
                                                                                     Proportion of stroke patients who receive a brain CT/MRI within 24 hours of                                                                                                                                                                                  Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                                                                                                                                                                           emergency department or inpatient care during             emergency department and receive first CT or MRI
                                                                                     hospital arrival                                                                                                                                                                                                                                             Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services - optional
                                                                                                                                                                           audit period                                              scan within 24 hours of arrival in emergency
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care                          indicator
                                                                                                                                                                                                                                     department                                                                                                   Heuschmann et al. Development and Implementation of
                                                                                                                                                                                                                                     patients receiving first brain imaging within ≤1 hour                                                        Evidence-Based Indicators for Measuring Quality of Acute
                                                                                                                                                                           all patients hospitalized within ≤2 hours after stroke
                                                                                     Percentage of patients receiving first brain imaging within ≤1 hour after                                                                       after admission among all patients hospitalized                                                              Stroke Care
                                                                                                                                                                           onset and with adequate stroke severity to perform
                                                                                     admission among all patients hospitalized within ≤2 hours after stroke onset                                                                    within ≤2 hours after stroke onset and with                                                                  The Quality Indicator Board of the German Stroke
                                                                                                                                                                           intravenous thrombolysis (NIHSS on admission
                                                                                     and with adequate stroke severity to perform intravenous thrombolysis (NIHSS                                                                    adequate stroke severity to perform intravenous                                                              Registers Study Group (ADSR). Stroke. 2006; 37: 2573-
                                                                                                                                                                           between 4 and 25) and between 18 and 80 years of
                                                                                     on admission between 4 and 25) and between 18 and 80 years of age.                                                                              thrombolysis (NIHSS on admission between 4 and 25)                                                           2551
                                                                                                                                                                           age.
3. Brain imaging                                                                                                                                                                                                                     and between 18 and 80 years of age.                                                                                                                                       Germany                                                                                                                                                   A
                                                                                     percentage of final reports for CT or MRI studies of the brain performed within       All final reports for computed tomography (CT) or         Final reports of the initial computed tomography                                                             American Academy of Neurology, American College of
                                                                                     24 hours of arrival to the hospital for patients aged 18 years and older with         magnetic resonance imaging (MRI) studies of the           (CT) or magnetic resonance imaging (MRI) that                                                                Radiology, Physician Consortium for Performance
                                                                                     either a diagnosis of ischemic stroke or TIA or intracranial hemorrhage or at         brain performed within 24 hours of arrival to the         include documentation of the presence or absence of                                                          Improvement®, National Committee for Quality                                                                                                                                                                                       National Quality Measures
                                                                                                                                                                           hospital for patients aged 18 years and older with                                                                                                                     Assurance. Stroke and stroke rehabilitation physician        US
                                                                                     least one documented symptom consistent with ischemic stroke or TIA or                                                                          each of the following: hemorrhage and mass lesion                                                                                                                                                                                                                                                                                               Clearinghouse
                                                                                     intracranial hemorrhage that include documentation of the presence or absence         either a diagnosis of ischemic stroke or transient        and acute infarction                                                                                         performance measurement set. Chicago (IL): American
                                                                                     of each of the following: hemorrhage and mass lesion and acute infarction             ischemic attack (TIA) or intracranial hemorrhage OR                                                                                                                    Medical Association (AMA), National Committee for
                                                                                                                                                                           at least one documented symptom consistent with                                                                                                                        Quality Assurance (NCQA); 2009 Feb. 20 p.
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                                                     Clear diagnosis of site/type of lesion                                                                                                                                                                                                                       rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                     Proportion of all thrombolysed ischemic stroke patients who receive acute             All patients who receive IV tPA                           Number/percentage of patients who receive IV tPA                                                             Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                                                                                     thrombolytic therapy within one hour of hospital arrival                                                                                        within 1 hour of hospital arrival                                                                            Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services -
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care                          mandatory indicator
                                                                                     percent of acute ischemic stroke patients for whom IV thrombolytic therapy            Acute ischemic stroke patients whose time of arrival      Acute ischemic stroke patients for whom IV                                                                   Specifications manual for national hospital inpatient                                                                                                                                                                                                            The Joint Commission's
                                                                                                                                                                                                                                     thrombolytic therapy was initiated at this hospital                                                          quality measures, version 3.1a. Centers for Medicare &                                                                                                                                                                             National Quality Measures
                                                                                     was initiated at the hospital within 3 hours (less than or equal to 180 minutes)      is within 2 hours (less than or equal to 120 minutes)                                                                                                                                                                               US                                                                                                                                                                                                  Primary Stroke Center
                                                                                                                                                                                                                                     within 3 hours (less than or equal to 180 minutes) of                                                        Medicaid Services (CMS), The Joint Commission; 2010 Apr                                                                                                                                                                            Clearinghouse
                                                                                     of time last known well                                                               of time last known well                                                                                                                                                                                                                                                                                                                                                                                                                 Certification
                                                                                                                                                                                                                                     time last known well                                                                                         1. various p.
                               Ischemic                      Acute
                                                                                                                                                                                                                                                                                                                                                                                                                                                      - 1 Cochrane review: Wardlaw JM, Murray V, Berge E, Del Zoppo GJ. Thrombolysis for acute
                                                                                     Percent of patients with acute ischemic stroke who arrive at the hospital Patients with acute ischemic stroke with hospital                     Patients for whom IV thrombolytic therapy was
                                                                                                                                                                                                                                                                                                                                                                                                                                                     ischemic stroke. Cochrane database syst rev. 2009A, Issue 4. CD000213 (1++)                                                     Quality        Enhancement
                                                                                     within 120 minutes (2 hours) of symptom onset for whom IV t-PA was initiated arrival time within 2 hours (< 120 minutes) after                  initiated at this hospital within 3 hours (≤ 180                                                             United States Department of Veterans Affairs, 2009           US
                                                                                                                                                                                                                                                                                                                                                                                                                                                      - 1 meta-analysis: Lansberg MG, Bluhmki E, Thijs VN, Saver JL. Efficacy and safety of tissue                                   Research Initiative
                                                                                     at this hospital within 180 minutes (3 hours) of symptom onset               symptom onset                                                      minutes) of symptom onset
                                                                                                                                                                                                                                                                                                                                                                                                                                                     plaminogen activator 3 to 4.5 hours after acute ischemic stroke. A metaanalysis. Stroke.
4. Thrombolytic therapy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  A
                                                                                                                                                                                                                                                                                                                                                                                                                                                     2009;40(7):2438-41. (1++)
                                                                                                                                                                                                                                                                                                                                                  Centers for Disease Control and Prevention (CDC): Stroke                                            - 8 clinical guidelines: American Stroke Association, National Stroke Association UK, National
                                                                                                                                                                                                                                                                                                                                                  Performance Measure Set following harmonization of                                                 Stroke Foundation Australia
                                                                                     Acute ischemic stroke patients who arrive at the hospital within 120 minutes (2       All patients with acute ischemic stroke whose time        The number of patients for whom IV thrombolytic
                                                                                                                                                                                                                                                                                                                                                  measure specifications with the Paul Coverdell National                                             - 5 national/regional audit: Belgium, Germany, UK, Sweden                                                                      Centers for Disease Control
                               Ischemic/TIA                  Acute                   hours) of time last known well and for whom IV t-PA was initiated at this             of arrival is within 2 hours (120 minutes) of time last   therapy was initiated at this hospital within 3 hours                                                                                                                     US
                                                                                                                                                                                                                                                                                                                                                  Acute Stroke Registry and American Heart Association /                                                                                                                                                                             and Prevention (CDC)
                                                                                     hospital within 180 minutes (3 hours) of time last known well.                        known well.                                               (≤ 180 minutes) of time last known well.
                                                                                                                                                                                                                                                                                                                                                  American Stroke Association GET WITH THE GUIDELINES,
                                                                                                                                                                                                                                                                                                                                                  and after endorsement by NQF
                                                                                                                                                                                                                                                                                                                                                  American Academy of Neurology, American College of
                                                                                                                                                                           All patients aged 18 years and older with the             Patients from the denominator who were considered                                                            Radiology, Physician Consortium for Performance
                               Adult ischemic stroke                                 percentage of patients aged 18 years and older with the diagnosis of ischemic         diagnosis of ischemic stroke whose time from              for tissue plasminogen activator (t-PA)                                                                      Improvement®, National Committee for Quality                                                                                                                                                                                       National Quality Measures
                               patient arrived hospital in   Acute                   stroke whose time from symptom onset to arrival is less than 3 hours who              symptom onset to arrival is less than 3 hours             administration (given t-PA or documented reasons                                                             Assurance. Stroke and stroke rehabilitation physician        US
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Clearinghouse
                               3h of onset                                           were considered for tissue plasminogen activator (t-PA) administration                                                                          for patient not being a candidate for therapy)                                                               performance measurement set. Chicago (IL): American
                                                                                                                                                                                                                                                                                                                                                  Medical Association (AMA), National Committee for
                                                                                                                                                                                                                                                                                                                                                  Quality Assurance (NCQA); 2009 Feb. 20 p.
                                                                                                                                                                                                                                                                                                                                                  National Stroke Foundation. Acute stroke services                                                                                                                                                                                                                Acute Stroke Service
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     National Quality Measures
                                                                                                                                                                                                                                                                                                                                                  framework 2008. Melbourne VIC: National Stroke               Australia                                                                                                                                                                                           Framework 2011: National
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Clearinghouse
                                                                                                                                                                                                                                                                                                                                                  Foundation; 2008. 37 p.                                                                                                                                                                                                                                          Performance Indicator set
                                                                                                                                                                                                                                                                                                                                                  Institute for Clinical Systems Improvement (ICSI).
                                                                                                                                                                                                                                                                                                                                                  Diagnosis and treatment of ischemic stroke. Bloomington                                                                                                                                                                            National Quality Measures
                                                                                                                                                                                                                                                                                                                                                                                                               US
                                                                                                                                                                                                                                                                                                                                                  (MN): Institute for Clinical Systems Improvement (ICSI);                                                                                                                                                                           Clearinghouse
                                                                                                                                                                           All patients aged 18 years and older with the             Patients who underwent a dysphasia screening                                                                 2010 Jun. 70 p.
                                                                                     percentage of patients aged 18 years and older with the diagnosis of ischemic                                                                                                                                                                                American Academy of Neurology, American College of
                                                                                                                                                                           diagnosis of ischemic stroke or intracranial              process before taking any foods, fluids or medication
                                                                                     stroke or intracranial hemorrhage who underwent a dysphasia screening                                                                                                                                                                                        Radiology, Physician Consortium for Performance                                                                                                                                                                                    National Quality Measures
                                                                                                                                                                           hemorrhage who receive any foods, fluids or               by mouth                                                                                                                                                                  US
                                                                                     process before taking any foods, fluids or medication by mouth                                                                                                                                                                                               Improvement®, National Committee for Quality                                                                                                                                                                                       Clearinghouse
                                                                                                                                                                           medication by mouth                                                                                                                                                                                                                                                        - 1 HTA report: Report/Technology Assessment No. 8, Diagnosis and Treatment of Swallowing
                                                                                                                                                                                                                                                                                                                                                  Assurance. Stroke and stroke rehabilitation physician of
                                                                                                                                                                                                                                                                                                                                                  Heuschmann et al. Development and Implementation                                                   Disorders (Dysphasia) in Acute-Care Stroke Patients. (AHCPR Publication No. 99-E024).
                                                                                                                                                                                                                                                                                                                                                  Evidence-Based Indicators for Measuring Quality of Acute                                            - 2 systematic reviews:
                                                                                                                                                                                                                                                                                                                                                  Stroke Care                                                                                                   Perry L, Love CP. Screening for dysphasia and aspiration in acute stroke: A systematic
                                                                                                                                                                                                                                                                                                                                                  The Quality Indicator Board of the German Stroke             Germany                               review. Dysphasia. 2011; 16(1):7-18. (1++)
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-                                                    Langhorne P, Dey P, Woodman M, Kalra L,Wood-Dauphinee S, Patel N, Hamrin E. Is
                                                                                                                                                                                                                                                                                                                                                  Based Performance Measures. Results From the First                                                                                                                                                                                                               The Stroke Programme,
                                                                                                                                                                                                                                                                                                                                                                                                               Spain                                 stroke unit care portable? A systematic review of clinical trials. Age Aging 2005; 34:324–30
                                                                                                                                                                                                                                                                                                                                                  Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                                                                                                                     (1++).
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1439                                                                                  - 2 RCTs:
                                                                                                                                                                                                                                                                                                                                                  NHS UK/Royal College of Physicians website: Sentinel                                                         Evans A, Perez I, Harraf F, Melbourn A, Steadman J, Donaldson N, Kalra L. Can differences                             NHS UK/Royal College of       National Sentinel Stroke
                                                                                     Screened for swallowing disorders within first 24 hours of admission                                                                                                                                                                                                                                                      UK
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                       in management processes explain different outcomes between stroke unit and stroke-team                                          Physicians                    Clinical Audit
5. Swallow/dysphasia                                         Acute
                               All                                                                                                                                                                                                                                                                                                                                                                                                                   care? Lancet 2001;358:1586–92. (1+)                                                                                 A
screen
                                                                                     Proportion of patients with documentation of an initial dysphasia screening           Total number of stroke patients admitted to the           Number of all stroke patients who have                                                                                                                                                                                   Carnaby G, Hanket GJ, Pizzi J. Behavioural intervention for dysphasia in acute stroke: a
                                                                                                                                                                                                                                                                                                                                                  Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                                                                                     during admission to ED or acute inpatient care or inpatient rehabilitation (since     emergency department, acute inpatient care or             documentation that a dysphasia screening was                                                                                                                                                                    randomized controlled trial. Lancet neurol. 2006; 5(1):31-7 (1+)
                                                                                                                                                                                                                                                                                                                                                  Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services -
                                                                                     2010)                                                                                 inpatient rehabilitation                                  performed                                                                                                                                                                                                        - 1 prospective study: Cadilhac D, Ibrahim J, Pearce D et al. Multicentre comparison of process
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care                          mandatory indicator
                                                                                                                                                                                                                                                                                                                                                                                                                                                     of care between stroke units and conventional care wards in Australia. Stroke 2004;
                                                                                                                                                                                                                                                                                             - Germany: 90%                                       Variations in Quality Indicators of Acute Stroke Care in 6
                                                                                                                                                                                                                                                                                                                                                                                                                                                     35:1035–40. (2++)
                                                                                     Swallowing test                                                                                                                                                                                         - Scotland: 100%                                     European Countries: The European Implementation Score        Belgium, Germany, UK, Spain, Sweden    - 1 retrospective study: Mohammed M, Mant J, Bentham L, Raftery J. Comparing processes of
                                                                                                                                                                                                                                                                                             - Catalonia-Spain: improvement since the 1st audit   (EIS) Collaboration. Wiedmann et al. Stroke. 2012;43:00-
                                                                                                                                                                                                                                                                                                                                                                                                                                                     stroke care in high- and low mortality hospitals in the West Midlands UK. Int J Qual Health Care
                                                                                                                                                                                                                                                                                                                                                  00.
                                                                                                                                                                                                                                                                                                                                                  Centers for Disease Control and Prevention (CDC): Stroke                                           2005; 17:31–6. (2+)
                                                                                     Patients with ischemic or hemorrhagic stroke who undergo screening for                                                                                                                                                                                       Performance Measure Set following harmonization of                                                  - 9 clinical guidelines: National Stroke Foundation Australia, American Veterans Affairs, NICE,
                                                                                                                                                                           All patients with acute ischemic or hemorrhagic           Patients who were screened for dysphasia before                                                              measure specifications with the Paul Coverdell National                                            Scottish Intercollegiate Guideline Network                                                                                      Centers for Disease Control
                                                                                     dysphasia with an evidence-based bedside testing protocol before being given                                                                                                                                                                                                                                              US
                                                                                                                                                                           stroke                                                    taking any food, fluids, or medications by mouth                                                             Acute Stroke Registry and American Heart Association /                                              - 8 national/regional audit: UK, Germany, Spain, Sweden                                                                        and Prevention (CDC)
                                                                                     any food, fluids, or medication by mouth.
                                                                                                                                                                                                                                                                                                                                                  American Stroke Association GET WITH THE GUIDELINES,
                                                                                                                                                                                                                                                                                                                                                  and after endorsement by NQF
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                                                                                                                                                                                                                                                                                                                  rehabilitation interventions used to measure quality of
                                                                                     Patients screened for communication/language defects                                                                                                                                                                                                                                                                      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–84

                                                                                     Proportion of patients assessed by bedside screening in order to determine the
                                                                                     extent of aspiration and the severity of swallow dysfunction no later than the                                                                                                                          ≥90%                                                 The Danish National Indicator Project http://www.nip.dk/     Denmark
                                                                                     first day of hospitalization
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-
                               All                           Acute                                                                                                                                                                                                                                                                                Based Performance Measures. Results From the First                                                                                                                                                                                                               The Stroke Programme,
6. BP                                                                                Baseline determination of BP, at the ED                                                                                                                                                                                                                                                                                   Spain                                 Unknown                                                                                                             D
                                                                                                                                                                                                                                                                                                                                                  Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1438
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-                                           - 1 RCT: Evans A, Perez I, Harraf F, Melbourn A, Steadman J, Donaldson N, Kalra L. Can
                               All                           Acute                                                                                                                                                                                                                                                                                Based Performance Measures. Results From the First                                                 differences in management processes explain different outcomes between stroke unit and stroke-                                                                The Stroke Programme,
7. Glycemia                                                                          Baseline determination of glycemia, at the ED                                                                                                                                                                                                                                                                             Spain                                                                                                                                                     B
                                                                                                                                                                                                                                                                                                                                                  Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                              team care? Lancet 2001;358:1586–92. (1+)                                                                                                                      Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1439                                                                                   - 1 retrospective case review: Mohammed M, Mant J, Bentham L, Raftery J. Comparing
Early acute management (24-48 h)
                                                                                                                                                                           All stroke patients (International Classification of
                                                                                                                                                                           Diseases, Tenth Revision [ICD-10] code) admitted to                                                                                                                    National Stroke Foundation. Acute stroke services                                                                                                                                                                                                                Acute Stroke Service
                                                                                     percentage of stroke patients admitted to stroke unit during acute hospital                                                                     Total number of stroke patients admitted to hospital                                                                                                                                                                                                                                                                                            National Quality Measures
                                                                                                                                                                           hospital during audit period                                                                                                                                           framework 2008. Melbourne VIC: National Stroke               Australia                                                                                                                                                                                           Framework 2011:
                                                                                     stay during audit period                                                                                                                        (TIA, ischemic, hemorrhage)                                                                                                                                                                                                                                                                                                                     Clearinghouse
                                                                                                                                                                                                                                                                                                                                                  Foundation; 2008. 37 p.                                                                                                                                                                                                                                          minimum data set


                                                                                     Proportion of patients who are admitted to a stroke unit no later than the 2nd
                                                                                                                                                                                                                                                                                             ≥ 90%                                                The Danish National Indicator Project http://www.nip.dk/     Denmark
                                                                                     day of hospitalization
8. Treated in SU               All                           Acute                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       A

                                                                                                                                                                                                                                                                                                                                                  NHS UK/Royal College of Physicians website: Sentinel                                                                                                                                                                               NHS UK/Royal College of       National Sentinel Stroke
                                                                                     Patients treated for 90% of stay in a Stroke Unit (as calculated)                                                                                                                                                                                                                                                         UK
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                                                                                                                                                       Physicians                    Clinical Audit


                                                                                     The proportion of all acute stroke patients who are managed on a designated                                                                     Number of stroke patients admitted to hospital and
                                                                                                                                                                           Total number of stroke patients admitted to hospital
                                                                                     geographically defined integrated, acute, and/or rehabilitation stroke unit at                                                                  treated on an acute stroke unit at any time during                                                           Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                                                                                                                                                                           (TIA, ischemic, hemorrhage)
                                                                                     any point during hospitalization                                                                                                                hospital stay                                                                                                Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services -
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care                          mandatory indicator
                                                                                                                                                                           patients with ischemic stroke or TIA if an                patients after ischemic stroke or TIA treated with                                                           Heuschmann et al. Development and Implementation of
                                                                                     Percentage of patients after ischemic stroke or TIA treated with antiplatelets
                                                                                                                                                                           intracranial haemorrhage and contraindications            antiplatelets within ≤48 hours after stroke onset if                                                         Evidence-Based Indicators for Measuring Quality of Acute
                                                                                     within ≤48 hours after stroke onset if an intracranial haemorrhage and
                                                                                                                                                                           against antiplatelets are excluded. Patients <18          an intracranial haemorrhage and contraindications                                                            Stroke Care
                               Ischemic or TIA               Acute                   contraindications against antiplatelets are excluded. Patients <18 years,
                                                                                                                                                                           years, patients receiving anticoagulants and              against antiplatelets are excluded. Patients <18                                                             The Quality Indicator Board of the German Stroke
                                                                                     patients receiving anticoagulants and patients admitted >48 hours after stroke
                                                                                                                                                                           patients admitted >48 hours after stroke onset are        years, patients receiving anticoagulants and                                                                 Registers Study Group (ADSR). Stroke. 2006; 37: 2573-
                                                                                     onset are excluded.
                                                                                                                                                                           excluded.                                                 patients admitted >48 hours after stroke onset are                                                           2551                                                         Germany
                                                                                                                                                                                                                                     excluded.
                                                                                                                                                                                                                                     Number of ischemic stroke/TIA patients who receive                                                           Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
9. Early antiplatelet                                                                Proportion of acute ischemic stroke and TIA patients who receive acute                Total number of ischemic stroke/TIA patients seen in
                               Ischemic or TIA               Acute                                                                                                                                                                   acute aspirin therapy within the first 48 hrs                                                                Update 2010. CSS Information & Evaluation Working                                                                                                                                                                      A           Recommendation for Stroke     Stroke Services - optional
administration                                                                       antiplatelet therapy within the first 48h hours of hospital arrival (since 2010)      the emergency department or admitted to inpatient
                                                                                                                                                                                                                                     following a stroke event                                                                                     Group. June 2010.                                            Canada                                                                                                                                                                Care                          indicator
                                                                                     percentage of stroke patients diagnosed with an ischemic stroke with                  Total number of ischaemic stroke patients admitted        Number of stroke patients diagnosed with an                                                                  National Stroke Foundation. Acute stroke services                                                                                                                                                                                                                Acute Stroke Service
                                                                                                                                                                                                                                     ischaemic stroke with documented evidence of                                                                                                                                                                                                                                                                                                    National Quality Measures
                               All                           Acute                   documented evidence of aspirin administration administered within 48 hours of         to hospital during audit period                                                                                                                                        framework 2008. Melbourne VIC: National Stroke               Australia                                                                                                                                                                                           Framework 2011: National
                                                                                                                                                                                                                                     aspirin administered within 48 hours of presentation                                                                                                                                                                                                                                                                                            Clearinghouse
                                                                                     presentation to hospital during audit period                                                                                                                                                                                                                 Foundation; 2008. 37 p.                                                                                                                                                                                                                                          Performance Indicator set
                                                                                                                                                                                                                                     to hospital during audit period, contra-indicators
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               Thrombotic/thromboembol                                                                                                                                                                                                                                                                                            rehabilitation interventions used to measure quality of
                                                             Acute                   Commencement of aspirin with 48h for thrombotic/thromboembotic stroke                                                                                                                                                                                                                                                     Various countries
                               ic stroke                                                                                                                                                                                                                                                                                                          acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                     Ischemic or hemorrhagic stroke patients who                                                                  Specifications manual for national hospital inpatient
                                                                                     percent of ischemic and hemorrhagic stroke patients who have received venous                                                                    received venous thromboembolism (VTE) prophylaxis                                                            quality measures, version 3.1a. Centers for Medicare &                                                                                                                                                                                                           The Joint Commission's
                                                             Acute                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   National Quality Measures
                               All                                                   thromboembolism (VTE) prophylaxis or who have documentation why no VTE                Ischemic or hemorrhagic stroke patients                   or have documentation why no VTE prophylaxis was                                                             Medicaid Services (CMS), The Joint Commission; 2010 Apr      US                                                                                                                                                                                                  Primary Stroke Center
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Clearinghouse
                                                                                     prophylaxis was given the day of or the day after hospital admission                                                                            given on the day of or the day after hospital                                                                1. various p.                                                                                                                                                                                                                                                    Certification
                                                                                                                                                                                                                                     admission
10. VTE prophylaxis                                                                                                                                                                                                                                                                                                                               Quality of In-Hospital Stroke Care According to Evidence-                                                                                                                                                              C
                               bedridden/hemiparetic         Acute                                                                                                                                                                                                                                                                                Based Performance Measures. Results From the First                                                                                                                                                                                                               The Stroke Programme,
                                                                                     DVT prevention among bedridden/hemiparetic patients with proper measures                                                                                                                                                                                                                                                  Spain
                               patients                                                                                                                                                                                                                                                                                                           Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1439
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                             Acute                   DVT prophylaxis (compression stockings & /or heparin/low-molecular weight                                                                                                                                                                                    rehabilitation interventions used to measure quality of
                               All                                                                                                                                                                                                                                                                                                                                                                             Various countries
                                                                                     heparin)                                                                                                                                                                                                                                                     acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Variations in Quality Indicators of Acute Stroke Care in 6
                                                                                                                                                                                                                                                                                             - Germany: 90%                                       European Countries: The European Implementation Score
                                                                                     Assessment for rehabilitation (PT/OT)                                                                                                                                                                                                                                                                                     Belgium, Germany, UK, Spain, Sweden
                                                                                                                                                                                                                                                                                             - Catalonia-Spain: improvement since the 1st audit   (EIS) Collaboration. Wiedmann et al. Stroke. 2012;43:00-
                                                                                                                                                                                                                                                                                                                                                  00.
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-
                                                                                     Assessment of the establishment of rehabilitation                                                                                                                                                                                                            Based Performance Measures. Results From the First                                                                                                                                                                                                               The Stroke Programme,
                                                                                                                                                                                                                                                                                                                                                                                                               Spain
                                                                                     treatment within the first 5 days                                                                                                                                                                                                                            Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1438
                                                                                     Proportion of stroke patients with a rehabilitation assessment within 48 hours                                                                                                                                                                               Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                                                                                     of hospital admission for acute ischemic stroke and within 5 days of admission                                                                                                                                                                               Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services - optional
                                                                                     for hemorrhagic stroke.                                                                                                                                                                                                                                      Group. June 2010.                                            Canada                                                                                                                                                                Care                          indicator
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                                                     Assessment by a physiotherapist                                                                                                                                                                                                                              rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                           Total number of stroke patients admitted to hospital      Number of stroke patients with documented                                                                    National Stroke Foundation. Acute stroke services                                                                                                                                                                                                                Acute Stroke Service
                                                                                     percentage of stroke patients with documented physiotherapy assessment                during audit period                                                                                                                                                                                                                                                                                                                                                                                       National Quality Measures
                                                                                                                                                                                                                                     physiotherapy assessment within 48 hours of                                                                  framework 2008. Melbourne VIC: National Stroke               Australia                                                                                                                                                                                           Framework 2011: National
                                                                                     within 48 hours of admission to hospital during audit period                                                                                                                                                                                                                                                                                                                                                                                                                                    Clearinghouse
                                                                                                                                                                                                                                     admission to hospital during audit period                                                                    Foundation; 2008. 37 p.                                                                                                                                                                                                                                          Performance Indicator set

                                                                                     Proportion of patients assessed by a physiotherapist no later than the 2nd day
                                                                                     of hospitalization in order to clarify of the extent and type of rehabilitation and                                                                                                                     ≥90%                                                 The Danish National Indicator Project http://www.nip.dk/     Denmark
                               All                           Acute                   time for initiation of physiotherapy

                                                                                                                                                                                                                                                                                                                                                  NHS UK/Royal College of Physicians website: Sentinel                                                                                                                                                                               NHS UK/Royal College of       National Sentinel Stroke
                                                                                     Physiotherapy assessment within first 72 hours of admission                                                                                                                                                                                                                                                               UK
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                                                                                                                                                       Physicians                    Clinical Audit

                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
11. Early
                                                                                     Occupational therapist assessment                                                                                                                                                                                                                            rehabilitation interventions used to measure quality of      Various countries
mobilization/rehabilitation
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
(including assessment) by
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
PT/OT/SP
                                                                                     Proportion of patients assessed by an occupational therapist no later than the                                                                                                                                                                                                                                                                                                                                                                                                      A
                                                                                     2nd day of hospitalization in order to clarify of the extent and type of                                                                                                                                ≥90%                                                 The Danish National Indicator Project http://www.nip.dk/     Denmark
(PT: physiotherapist
                                                                                     rehabilitation and time for initiation of occupational therapy
OT: occupational therapist
ST: speech therapist)
                                                                                                                                                                                                                                                                                                                                                  NHS UK/Royal College of Physicians website: Sentinel                                                                                                                                                                               NHS UK/Royal College of       National Sentinel Stroke
                                                                                     Assessment by an Occupational Therapist within 4 working days of admission                                                                                                                                                                                                                                                UK
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                                                                                                                                                       Physicians                    Clinical Audit

                                                                                                                                                                                                                                     Number of stay for which the evaluation by a                                                                 HAS: Présentation du thème « Prise en charge initiale de
                                                                                                                                                                                                                                                                                                                                                  l’accident vasculaire                                                                                                                                                                                                              HAS, Haute Autorité de
                                                                                     Percent of patient that received an evaluation by a rehabilitation professional       Number of stays for stroke                                rehabilitation professional is successfully traced                                                                                                                        France
                                                                                                                                                                                                                                                                                                                                                  cérébral » Available at: http://www.has-                                                                                                                                                                                           Santé
                                                                                                                                                                                                                                     back.
                                                                                                                                                                                                                                                                                                                                                  sante.fr/portail/upload/docs/application/pdf/2012-
                                                                                                                                                                                                                                     Median time (in days) between arrival in the                                                                 HAS: Présentation du thème « Prise en charge initiale de
                                                                                     Median time (in days) between hospital arrival and evaluation by a                                                                                                                                                                                           l’accident vasculaire                                                                                                                                                                                                              HAS, Haute Autorité de
                                                                                                                                                                           N/A                                                       institution and the evaluation by a rehabilitation                                                                                                                        France
                                                                                     rehabilitation professional                                                                                                                                                                                                                                  cérébral » Available at: http://www.has-                                                                                                                                                                                           Santé
                                                                                                                                                                                                                                     professional
                                                                                                                                                                                                                                                                                                                                                  sante.fr/portail/upload/docs/application/pdf/2012-
                                                                                                                                                                                                                                     patients with documented paresis on admission and
                                                                                     Percentage of patients with documented paresis on admission and substantial           patients with documented paresis on admission and         substantial functional deficit (Rankin Scale ≥3 or                                                           Heuschmann et al. Development and Implementation of
                               Patients with documented                                                                                                                                                                                                                                                                                           Evidence-Based Indicators for Measuring Quality of Acute
                                                                                     functional deficit (Rankin Scale ≥3 or Barthel Index ≤70 within first 24 hours        substantial functional deficit (Rankin Scale ≥3 or        Barthel Index ≤70 within first 24 hours after
                               paresis on admission and      Acute                   after admission) who were seen or treated by physiotherapist or occupational          Barthel Index ≤70 within first 24 hours after             admission) who were seen or treated by                                                                       Stroke Care
                               substantial functional
                                                                                     therapist within the first 2 days after admission. Patients with transient            admission). patients with transient ischemic attack       physiotherapist or occupational therapist within the                                                         The Quality Indicator Board of the German Stroke
                               deficit                                                                                                                                                                                                                                                                                                            Registers Study Group (ADSR). Stroke. 2006; 37: 2573-
                                                                                     ischemic attack (TIA) are excluded.                                                   (TIA) are excluded.                                       first 2 days after admission. Patients with transient
                                                                                                                                                                                                                                     ischemic attack (TIA) are excluded.                                                                          2551                                                         Germany
                                                                                                                                                                                                                                                                                                                                                  Variations in Quality Indicators of Acute Stroke Care in 6
                                                                                                                                                                                                                                                                                             - Germany: 90%                                       European Countries: The European Implementation Score
                                                                                     Early mobilization                                                                                                                                                                                                                                                                                                        Belgium, Germany, UK, Spain, Sweden
                                                                                                                                                                                                                                                                                             - Catalonia-Spain: improvement since the 1st audit   (EIS) Collaboration. Wiedmann et al. Stroke. 2012;43:00-
                                                                                                                                                                                                                                                                                                                                                  00.
                                                                                     Percent of ischemic stroke patients with stroke on arrival with completion of an
                                                                                                                                                                                                                                     Patients with an admission FIM assessment entered                                                                                                                                                                                                                                                                                               Quality        Enhancement
                               Ischemic                      Diagnosis               initial functional assessment (FIM) to assess the need for rehabilitation Patients with ischemic stroke on arrival                                                                                                                                           United States Department of Veterans Affairs, 2009           US
                                                                                                                                                                                                                                     into FSOD                                                                                                                                                                                                                                                                                                                                       Research Initiative
                                                                                     intervention

                                                                                     Percent of patients with fall risk assessment using the Morse Fall Scale                                                                        Patients with fall risk assessment using the Morse                                                                                                                                                                                                                                                                                              Quality        Enhancement
                               Ischemic                      Acute                                                                                                         Patients with ischemic stroke                                                                                                                                          United States Department of Veterans Affairs, 2009           US
                                                                                     completed by the end of hospital day two                                                                                                        Fall Scale completed by the end of hospital day two                                                                                                                                                                                                                                                                                             Research Initiative
12. Nutritional risk                                         Acute                   Proportion of patients who have an assessment of nutritional risk no later than
                               All                                                                                                                                                                                                                                                           ≥90%                                                 The Danish National Indicator Project http://www.nip.dk/     Denmark                               Unknown                                                                                                             D
assessment                                                                           the 2nd day of hospitalization
Inpatient care
                                                                                                                                                                                                                                                                                                                                                  Heuschmann et al. Development and Implementation of
                                                                                                                                                                                                                                     patients with ischemic stroke or TIA who receive                                                             Evidence-Based Indicators for Measuring Quality of Acute
                                                                                     Percentage of patients with ischemic stroke or TIA who receive vascular                                                                                                                                                                                      Stroke Care
                                                                                                                                                                           patients with ischemic stroke or TIA                      vascular imaging of extracranial arteries (Doppler or
                                                                                     imaging of extracranial arteries (Doppler or Duplex or DS-angiography or CT-                                                                                                                                                                                 The Quality Indicator Board of the German Stroke
                                                                                                                                                                                                                                     Duplex or DS-angiography or CT-angiography or MR-
                                                             Acute                   angiography or MR-angiography) during hospitalization.                                                                                                                                                                                                       Registers Study Group (ADSR). Stroke. 2006; 37: 2573-
13. Vascular imaging           All                                                                                                                                                                                                   angiography) during hospitalization.                                                                                                                                                                                                                                                                                                B
                                                                                                                                                                                                                                                                                                                                                  2551                                                         Germany

                                                                                     Proportion of patients who undergo an ultrasound/CT-angiography of the
                                                                                                                                                                                                                                                                                             ≥ 90%                                                The Danish National Indicator Project http://www.nip.dk/     Denmark
                                                                                     carotid arteries no later than the 4th day of hospitalization

                                                                                                                                                                                                                                                                                                                                                  Variations in Quality Indicators of Acute Stroke Care in 6
                                                                                     ECG during hospitalization                                                                                                                                                                                                                                   European Countries: The European Implementation Score        Belgium, Germany, UK, Spain, Sweden
                                                                                                                                                                                                                                                                                                                                                  (EIS) Collaboration. Wiedmann et al. Stroke. 2012;43:00-
14. ECG                        All                           Acute                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       A
                                                                                                                                                                                                                                                                                                                                                  00.
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                                                     Electrocardiogram                                                                                                                                                                                                                                            rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early                                            - 1 retrospective study: Kwan derWalt A, Gilligan AK, Cadilhac DA, Brodtmann AG, Pearce DC,
15. Echocardiography           Ischemic stroke               Acute                   Echocardiography in ischemic stroke                                                                                                                                                                                                                          rehabilitation interventions used to measure quality of      Various countries                     Donnan GA. Quality of stroke care within a hospital: effects of amobile stroke service. Med J                       D
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of                                          Aust 2005; 182:160–3. (2+)
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80                                                                    - 1 national/regional audit: Canada
16. Carotid                                                                          Wait time from ischemic stroke or TIA symptom onset to carotid                                                                                  Sum [LSN to carotid endarterectomy (CEA) time                                                                Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                               Ischemic or TIA               Acute                                                                                                         Number of CEA patients                                                                                                                                                                                                                                                    - Expert opinion: Consensus Review Panel Held December 2009 (Canada)                                                D
revascularization                                                                    revascularization                                                                                                                               (days) for all CEA patients]                                                                                 Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services - optional
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care                          indicator

                                                                                                                                                                                                                                                                                                                                                  NHS UK/Royal College of Physicians website: Sentinel                                                                                                                                                                               NHS UK/Royal College of       National Sentinel Stroke
                                                                                     Weighed at least once during admission                                                                                                                                                                                                                                                                                    UK
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                                                                                                                                                       Physicians                    Clinical Audit

                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Acute                   Glucose assessment                                                                                                                                                                                                                                           rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-
                               High risk patients with       Acute                   Establishment of an adequate antihypertensive                                                                                                                                                                                                                Based Performance Measures. Results From the First                                                                                                                                                                                                               The Stroke Programme,
                                                                                                                                                                                                                                                                                                                                                                                                               Spain
                               hypertension                                          treatment among targeted patients                                                                                                                                                                                                                            Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1439
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               Patients with fever >         Acute                                                                                                                                                                                                                                                                                rehabilitation interventions used to measure quality of
                                                                                     If documented fever > 38.5 °C was basic fever management instigated                                                                                                                                                                                                                                                       Various countries
17. Inpatient assessment       38.5°C                                                                                                                                                                                                                                                                                                             acute stroke care. Purvis et al. International Journal of
(weighing, glycaemia,                                                                                                                                                                                                                                                                                                                             Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-
hypertension, fever,                                         Acute                   Assessment of body temperature and prescription of antithermics when                                                                                                                                                                                         Based Performance Measures. Results From the First                                                                                                                                                                     A                                         The Stroke Programme,
dyslipidemia, incontinence,    All                                                                                                                                                                                                                                                                                                                                                                             Spain
                                                                                     necessary (temperature 37.5° C)                                                                                                                                                                                                                              Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
pressure sores etc.)
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1440
                                                                                                                                                                                                                                                                                                                                                  Quality of In-Hospital Stroke Care According to Evidence-
                                                             Acute                   Investigation of lipid profile and establishment of                                                                                                                                                                                                          Based Performance Measures. Results From the First                                                                                                                                                                                                               The Stroke Programme,
                               All                                                                                                                                                                                                                                                                                                                                                                             Spain
                                                                                     treatment when necessary                                                                                                                                                                                                                                     Audit of Stroke, Catalonia (Spain) 2005/2006. Stroke.                                                                                                                                                                                                            Catalonia, Spain
                                                                                                                                                                                                                                                                                                                                                  2009;40:1433-1439
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Acute                   Incontinence addressed, and a care plan formulated to avoid catheterisation                                                                                                                                                                                  rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                     Percent of patients with Braden Scale documented < 24 hours before or after                                                                     Patients with Braden Scale documented within < 24                                                                                                                                                                                                                                                                                               Quality        Enhancement
                               Ischemic                      Acute                                                                                                         Patients with ischemic stroke                                                                                                                                          United States Department of Veterans Affairs, 2009           US
                                                                                     admission                                                                                                                                       hours before or after admission                                                                                                                                                                                                                                                                                                                 Research Initiative
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Acute                   Risk assessment or plan to avoid pressure sores                                                                                                                                                                                                              rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Discharge               Patient/carer aware of diagnosis and prognosis                                                                                                                                                                                                               rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–81
18. Late-stage inpatient                                                                                                                                                                                                                                                                                                                          Systematic review of process indicators: including early
                                                             Discharge                                                                                                                                                                                                                                                                            rehabilitation interventions used to measure quality of                                                                                                                                                                D
rehabilitation                 All                                                   Patient/carer aware of therapy goals                                                                                                                                                                                                                                                                                      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–82
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Discharge               Social work assessment                                                                                                                                                                                                                                       rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
Discharge care                                                                                                                                                                                                                                                                                                                                    Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Discharge               Home visit performed before discharge                                                                                                                                                                                                                        rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–83
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Discharge               Documentation of living conditions                                                                                                                                                                                                                           rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
19. Discharge care plan                                                                                                                                                                                                                                                                                                                           Stroke Vol 4, April 2009, 72–83                                                                                                                                                                                        A
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Discharge               Patient/carer aware of discharge planning                                                                                                                                                                                                                    rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–83
                                                                                                                                                                                                                                     Number of stroke patients with documented care                                                               National Stroke Foundation. Acute stroke services                                                                                                                                                                                                                Acute Stroke Service
                                                                                     percentage of stroke patients with documented care plan developed and                 Total number of stroke patients' discharged from                                                                                                                                                                                                                                                                                                                                                          National Quality Measures     Framework 2011:
                               All                           Discharge                                                                                                                                                               plan developed and provided to patient/family prior                                                          framework 2008. Melbourne VIC: National Stroke               Australia
                                                                                     provided to patient/family prior to hospital discharge                                hospital during audit period                                                                                                                                                                                                                                                                                                                                                                              Clearinghouse                 Australian Stroke Clinical
                                                                                                                                                                                                                                     to hospital discharge during audit period                                                                    Foundation; 2008. 37 p.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Registry
                                                                                                                                                                                                                                     Ischemic stroke patients prescribed anticoagulation                                                          Specifications manual for national hospital inpatient                                                                                                                                                                                                            The Joint Commission's
                               Ischemic stroke patients                              percent of ischemic stroke patients with atrial fibrillation/flutter who are          Ischemic stroke patients with documented atrial                                                                                                                        quality measures, version 3.1a. Centers for Medicare &                                                                                                                                                                             National Quality Measures
                                                             Discharge                                                                                                                                                               therapy at hospital discharge                                                                                                                                             US                                                                                                                                                                                                  Primary Stroke Center
                               with AF/flutter                                       prescribed anticoagulation therapy at hospital discharge                              fibrillation/flutter                                                                                                                                                   Medicaid Services (CMS), The Joint Commission; 2010 Apr                                                                                                                                                                            Clearinghouse
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Certification
                                                                                                                                                                                                                                                                                                                                                  1. various p.
                                                                                                                                                                                                                                                                                                                                                  Centers for Disease Control and Prevention (CDC): Stroke
                                                                                     Patients with an ischemic stroke or hemorrhagic stroke who were assessed for          All patients with ischemic stroke, or hemorrhagic         Patients assessed for or who received rehabilitation                                                         Performance Measure Set following harmonization of                                                                                                                                                                                 Centers for Disease Control
                               All                           Discharge                                                                                                                                                                                                                                                                                                                                         US
                                                                                     rehabilitation services                                                               stroke                                                    services                                                                                                     measure specifications with the Paul Coverdell National                                                                                                                                                                            and Prevention (CDC)
                                                                                                                                                                                                                                                                                                                                                  Acute Stroke Registry and American Heart Association /
                                                                                     Proportion of patients with acute ischemic stroke and atrial fibrillation where                                                                                                                                                                                                                                                                                  - 1 RCT: Evans A, Perez I, Harraf F, Melbourn A, Steadman J, Donaldson N, Kalra L. Can
                                                             Before 14 days of
                                                                                     treatment with oral anticoagulants is initiated no later than the 14th day of                                                                                                                           ≥95%                                                 The Danish National Indicator Project http://www.nip.dk/     Denmark                               differences in management processes explain different outcomes between stroke unit and stroke-
                                                             hospitalization
                               Ischemic stroke patients                              hospitalization                                                                                                                                                                                                                                                                                                                                                 team care? Lancet 2001;358:1586–92. (1+)
20. Anticoagulation for AF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               B
                               with AF                                                                                                                                                                                                                                                                                                                                                                                                                - 8 clinical guidelines: American Stroke Association, Intercollegiate network Guidelines Network
                                                                                     Percent of patients with ischemic stroke on arrival who have atrial                   Patients with ischemic stroke and documented atrial                                                                                                                                                                                                                       (SIGN), New Zealand, VA/DoD (US)                                                                                                Quality Enhancement
                                                             Discharge                                                                                                                                                               Patients discharged on anticoagulation therapy                                                               United States Department of Veterans Affairs, 2009           US                                     - 6 national/regional audits: UK, Belgium, Germany, Spain, Sweden
                                                                                     fibrillation/flutter and are discharged on anticoagulation therapy                    fibrillation                                                                                                                                                                                                                                                                                                                                                                                              Research Initiative
                                                                                                                                                                                                                                                                                                                                                  Heuschmann et al. Development and Implementation of
                                                                                                                                                                           patients with ischemic stroke or TIA and atrial           patients with ischemic stroke or TIA and atrial                                                              Evidence-Based Indicators for Measuring Quality of Acute
                                                                                     Percentage of patients with ischemic stroke or TIA and atrial fibrillation            fibrillation who are discharged home or to an             fibrillation receiving anticoagulation at discharge                                                          Stroke Care
                                                                                     receiving anticoagulation at discharge who are discharged home or to an               inpatient rehabilitation unit and who are mobile          who are discharged home or to an inpatient                                                                   The Quality Indicator Board of the German Stroke
                               Ischemic stroke or TIA with
                                                           Discharge                 inpatient rehabilitation unit and who are mobile (Barthel Index Item “Transfer”       (Barthel Index Item “Transfer” 10–15 and Barthel          rehabilitation unit and who are mobile (Barthel                                                              Registers Study Group (ADSR). Stroke. 2006; 37: 2573-
                               AF
                                                                                     10–15 and Barthel Index Item “Mobility” 10–15) and minor disabled (Rankin             Index Item “Mobility” 10–15) and minor disabled           Index Item “Transfer” 10–15 and Barthel Index Item                                                           2551
                                                                                     Scale 0–3) at discharge. Patients <18 years are excluded                              (Rankin Scale 0–3) at discharge. Patients <18 years       “Mobility” 10–15) and minor disabled (Rankin Scale
                                                                                                                                                                           are excluded                                              0–3) at discharge. Patients <18 years are excluded                                                                                                                        Germany
                                                                                                                                                                                                                                                                                                                                                  Centers for Disease Control and Prevention (CDC): Stroke                                           - 1 prospective study: Cadilhac D, Ibrahim J, Pearce D et al. Multicentre comparison of process
21. Antiplatelet/              Ischemic/TIA                  Discharge               Patients with an ischemic stroke prescribed antithrombotic therapy at                                                                           Number of patients prescribed antithrombotic                                                                 Performance Measure Set following harmonization of                                                 of care between stroke units and conventional care wards in Australia. Stroke 2004;                                             Centers for Disease Control
                                                                                                                                                                           Number of patients with ischemic stroke                                                                                                                                                                                             US                                                                                                                                                        C
anticoagulant at discharge                                                           discharge                                                                                                                                       therapy at hospital discharge.                                                                               measure specifications with the Paul Coverdell National                                            35:1035–40. (1+)                                                                                                                and Prevention (CDC)
                                                                                                                                                                                                                                                                                                                                                  Acute Stroke Registry and American Heart Association /                                             - 6 clinical guidelines: UK, American Stroke Association, New Zealand
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                               All                           Discharge               Counseling for smoking cessation                                                                                                                                                                                                                             rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                                                                                                                                                                                                                                                                                  Centers for Disease Control and Prevention (CDC): Stroke
                                                                                                                                                                                                                                     Stroke patients (cigarette smokers) who receive
                                                                                                                                                                                                                                                                                                                                                  Performance Measure Set following harmonization of
                                                                                                                                                                           Ischemic stroke or hemorrhagic stroke patients with       smoking cessation advice or counseling during
                               All                           Discharge                                                                                                                                                                                                                                                                            measure specifications with the Paul Coverdell National                                                                                                                                                                            Centers for Disease Control
                                                                                                                                                                           a history of smoking cigarettes anytime during the        hospital stay, or documentation that patient’s                                                                                                                            US
22. Smoking cessation                                                                Patients with ischemic or hemorrhagic stroke with a history of smoking                                                                                                                                                                                       Acute Stroke Registry and American Heart Association /                                                                                                                                                                 D           and Prevention (CDC)
                                                                                                                                                                           year prior to hospital arrival                            caregiver was given smoking cessation advice or
                                                                                     cigarettes, who are, or whose caregivers are, given smoking cessation advice                                                                                                                                                                                 American Stroke Association GET WITH THE GUIDELINES,
                                                                                                                                                                                                                                     counseling during hospital stay.
                                                                                     or counseling during hospital stay. For the purposes of this measure, a smoker                                                                                                                                                                               and after endorsement by NQF
                                                                                     is defined as someone who has smoked cigarettes anytime during the year
                                                                                     prior to hospital arrival                                                                                                                       Patients who receive smoking cessation advice or
                                                                                                                                                                           Patients with ischemic or hemorrhagic stroke and a
                               All                           Discharge                                                                                                                                                               counseling during hospital stay, or documentation                                                                                                                                                                                                                                                                                               Quality Enhancement
                                                                                                                                                                           history of smoking cigarettes anytime during the                                                                                                                       United States Department of Veterans Affairs, 2009           US
                                                                                                                                                                                                                                     that patient’s caregiver was given smoking                                                                                                                                                                                                                                                                                                      Research Initiative
                                                                                                                                                                           year prior to hospital arrival
                                                                                                                                                                                                                                     cessation advice or counseling during hospital stay

                                                                                                                                                                                                                                     Stroke patients with documentation that they or                                                              Centers for Disease Control and Prevention (CDC): Stroke                                            - 1 systematic review: Langhorne P, Pollock Aon behalf of The Stroke Unit Trialists’
                                                                                     Patients with ischemic or hemorrhagic stroke or their caregivers who were
                                                                                                                                                                                                                                     their caregivers were given education and/or                                                                 Performance Measure Set following harmonization of                                                 Collaboration. What are the components of effective stroke unit care? Age Aging 2002;
                                                                                     given education and/or educational materials during the hospital stay
23. Patient/family                                           Discharge                                                                                                                                                               educational material addressing all of the following:                                                        measure specifications with the Paul Coverdell National                                            31:365–71 (1++)                                                                                                                 Centers for Disease Control
                               All                                                   addressing all of the following: personal risk factors for stroke, warning signs      Patients with ischemic stroke or hemorrhagic stroke                                                                                                                                                                                 US                                                                                                                                                        A
education                                                                                                                                                                                                                            1. Personal risk factors for stroke                                                                          Acute Stroke Registry and American Heart Association /                                              - 1 RCT: Lorig KR, Sobel DS, Stewart AL, et al. Evidence suggesting that a chronic disease self-                               and Prevention (CDC)
                                                                                     for stroke, activation of emergency medical system, need for follow-up after
                                                                                                                                                                                                                                     2. Warning signs for stroke                                                                                  American Stroke Association GET WITH THE GUIDELINES,                                               management program can improve health status while reducing hospitalization: A randomized
                                                                                     discharge, and medications prescribed at discharge.
                                                                                                                                                                                                                                     3. Activation of emergency medical system                                                                    and after endorsement by NQF                                                                       trial. Medical Care 1999;37:5-14. (1+)
                                                                                                                                                                           Patients in whom a new diagnosis of stroke or             4. Need forpatients from the denominator who have
                                                                                                                                                                                                                                     Number of follow-up after discharge                                                                          British Medical Association (BMA) and NHS Employers.                                                - 3 clinical guidelines: Kaiser Permanente Medical Group, Agency for Healthcare Research and
                                                                                     the percentage of new patients with a stroke or TIA who have been referred            transient ischaemic attack (TIA) has been made from       been referred for further investigation*                                                                     Quality and outcomes framework guidance for GMS                                                                                                                                                                                    National Quality Measures
                               All suspected stroke/TIA                                                                                                                                                                                                                                                                                                                                                        UK
                                                                                     for further investigation                                                             1 April 2008                                                                                                                                                           contract 2009/10. London (UK): British Medical                                                                                                                                                                                     Clearinghouse
                                                                                                                                                                                                                                     *Note: For the purposes of the Quality Outcomes                                                              Association, National Health Service Confederation; 2009
                                                                                     Proportion of patients with TIA who are investigated and discharged from the                                                                                                                                                                                 Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice        Accreditation Canada:
                               TIA                                                   emergency department who are referred to organized secondary stroke                                                                                                                                                                                          Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke     Stroke Services - optional
                                                                                     prevention services.                                                                                                                                                                                                                                         Group. June 2010.                                            Canada                                                                                                                                                                Care                          indicator
24. Transfer of service                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  D
                                                                                                                                                                                                                                                                                                                                                  HAS: Présentation du thème « Prise en charge initiale de
                                                                                     Median time (in days) between the date of demand of transfer to a service of                                                                                                                                                                                 l’accident vasculaire                                                                                                                                                                                                              HAS, Haute Autorité de
                               All                           Discharge                                                                                                     N/A                                                       N/A                                                                                                                                                                       France
                                                                                     following care and rehabilitation and the date of transfer                                                                                                                                                                                                   cérébral » Available at: http://www.has-                                                                                                                                                                                           Santé
                                                                                                                                                                                                                                                                                                                                                  sante.fr/portail/upload/docs/application/pdf/2012-
                                                                                     Percentage of patients referred to organized secondary stroke prevention                                                                                                                                                                                     Canadian Stroke Strategy Core Performance Indicator                                                                                                                                                                                Canadian Best Practice
                                                                                     services who are seen within 72 hours                                                                                                                                                                                                                        Update 2010. CSS Information & Evaluation Working                                                                                                                                                                                  Recommendation for Stroke
                                                                                                                                                                                                                                                                                                                                                  Group. June 2010.                                            Canada                                                                                                                                                                Care
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                                                                                                                                                                                                                                                                                                                  rehabilitation interventions used to measure quality of      Various countries
                                                                                                                                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                     Rehabilitation goals agreed by the multi-disciplinary team by discharge                                                                                                                                                                                      Stroke Vol 4, April 2009, 72–80
25. Rehabilitation goal                                      Discharge
                               All                                                                                                                                                                                                                                                                                                                NHS UK/Royal College of Physicians website: Sentinel                                                                                                                                                                   B           NHS UK/Royal College of       National Sentinel Stroke
setting                                                                                                                                                                                                                                                                                                                                                                                                        UK
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                                                                                                                                                       Physicians                    Clinical Audit

                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                                                     Individualized goals with reference to higher level function, i.e. driving,                                                                                                                                                                                  rehabilitation interventions used to measure quality of      Various countries
                                                                                     socializing, return to work                                                                                                                                                                                                                                  acute stroke care. Purvis et al. International Journal of
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80
                                                                                     percentage of stroke patients with documented evidence that antihypertensive          Total number of stroke patients discharged from           Number of stroke patients with documented                                                                    National Stroke Foundation. Acute stroke services                                                   - 2 RCTs:                                                                                                                                                    Acute Stroke Service
26. Antihypertensive                                                                 agent was prescribed and administered prior to discharge from the hospital                                                                      evidence that antihypertensive agent prescribed                                                                                                                                                                        Nazir FS, Overell JR, Bolster A, Hilditch TE, Reid JL, Lees KR. The effect of losartan on global                         National Quality Measures     Framework 2011:
                                                             Discharge                                                                                                     acute hospital care during audit period                                                                                                                                framework 2008. Melbourne VIC: National Stroke               Australia                                                                                                                                                 B
agent                                                                                during audit period.                                                                                                                            and administered prior to discharge from acute                                                                                                                                                                  and focal cerebral perfusion and on renal function in hypertensives in mild early ischaemic                                     Clearinghouse                 Australian Stroke Clinical
                                                                                                                                                                                                                                                                                                                                                  Foundation; 2008. 37 p.
                                                                                                                                                                                                                                     hospital care during audit period                                                                                                                                                                               stroke. Journal of hypertension. 2004;22(5):989-95. (1+)                                                                                                      Registry
                                                                                     Ischemic stroke patients with LDL > 100, or LDL not measured, or, who were on         All patients with an LDL ≥ 100 mg/dL, OR LDL not                                                                                                                       Centers for Disease Control and Prevention (CDC): Stroke
                                                                                                                                                                                                                                     Patients who were prescribed statin medication at                                                            Performance Measure Set following harmonization of                                                                                                                                                                                 Centers for Disease Control
                               Ischemic/TIA                  Discharge               cholesterol reducing therapy prior to hospitalization are discharged on statin        measured, OR who were on cholesterol reducing                                                                                                                                                                                       US
                                                                                                                                                                                                                                     hospital discharge                                                                                           measure specifications with the Paul Coverdell National                                                                                                                                                                            and Prevention (CDC)
                                                                                     medication (New and in pilot test in 2009)                                            therapy prior to hospitalization
                                                                                                                                                                                                                                                                                                                                                  Acute Stroke Registry and American Heart Association /
                                                                                     percent of ischemic stroke patients with LDL greater than or equal to 100             Ischemic stroke patients with a low-density               Ischemic stroke patients prescribed statin                                                                   Specifications manual for national hospital inpatient                                                                                                                                                                                                            The Joint Commission's
                               Ischemic stroke patients      Discharge                                                                                                     lipoprotein (LDL) greater than or equal to 100 mg/dL,                                                                                                                  quality measures, version 3.1a. Centers for Medicare &                                                                                                                                                                             National Quality Measures
                                                                                     mg/dL, or LDL not measured, or who were on a lipid-lowering medication prior                                                                    medication at hospital discharge                                                                                                                                          US                                                                                                                                                                                                  Primary Stroke Center
                               with high LDL level                                                                                                                         or LDL not measured, or who were on a lipid-                                                                                                                           Medicaid Services (CMS), The Joint Commission; 2010 Apr                                                                                                                                                                            Clearinghouse
                                                                                     to hospital arrival, who are prescribed a statin medication at hospital discharge                                                                                                                                                                                                                                                                                                                                                                                                                                             Certification
                                                                                                                                                                           lowering medication prior to hospital arrival                                                                                                                          1. various p.
                                                                                                                                                                                                                                                                                                                                                  Systematic review of process indicators: including early
                                                             Discharge               Statin therapy on discharge                                                                                                                                                                                                                                  rehabilitation interventions used to measure quality of      Various countries                      - 1 RCT: High-Dose Atorvastatin after Stroke or Transient Ischemic Attack. The Stroke
27. Cholesterol reducing                                                                                                                                                                                                                                                                                                                          acute stroke care. Purvis et al. International Journal of                                          Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. NEJM Vol. 355
                                                                                                                                                                                                                                                                                                                                                  Stroke Vol 4, April 2009, 72–80                                                                                                                                                                                        B
medication                                                                                                                                                                                                                                                                                                                                                                                                                                           2006:549-559. (1+)
                                                                                     Percent of patients with ischemic stroke on arrival with LDL>100 mg/dL, or LDL        Ischemic stroke patients with inpatient LDL > 100
                                                                                                                                                                                                                                     Patients who were prescribed cholesterol-reducing                                                                                                                                                               - 7 clinical guidelines: AHA/ASA (US), New Zealand                                                                              Quality Enhancement
                               Ischemic                      Discharge               not measured, or on cholesterol-reducer prior to admission, who are discharged        mg/dL OR who had LDL > 100 mg/dL within 30 days                                                                                                                        United States Department of Veterans Affairs, 2009           US
                                                                                                                                                                           prior to admission OR who were on cholesterol-            therapy at hospital discharge                                                                                                                                                                                                                                                                                                                   Research Initiative
                                                                                     on cholesterol reducing drugs.
                                                                                                                                                                           reducing therapy prior to hospitalization OR LDL not
                                                                                                                                                                           All Ischemic stroke patients with an LDL ≥ 100 mg/dL                                                                                                                   Centers for Disease Control and Prevention (CDC): Stroke
                               Ischemic/TIA                  Discharge               Ischemic stroke patients with LDL>100, or LDL not measured, or on cholesterol-                                                                  Patients who were prescribed cholesterol reducing                                                            Performance Measure Set following harmonization of                                                                                                                                                                                 Centers for Disease Control
                                                                                                                                                                           OR who were on cholesterol reducing therapy prior                                                                                                                                                                                   US
                                                                                     reducer prior to admission, who are discharged on cholesterol reducing drugs.                                                                   therapy at hospital discharge                                                                                measure specifications with the Paul Coverdell National                                                                                                                                                                            and Prevention (CDC)
                                                                                                                                                                           to hospitalization OR LDL not measured
                                                                                                                                                                                                                                                                                                                                                  Acute Stroke Registry and American Heart Association /
                                                                                                                                                                                                                                                                                                                                                  Variations in Quality Indicators of Acute Stroke Care in 6
                                                             Discharge               Discharge on lipid lowering therapy                                                                                                                                                                     Catalonia-Spain: improvement since the 1st audit     European Countries: The European Implementation Score        Belgium, Germany, UK, Spain, Sweden
                                                                                                                                                                                                                                                                                                                                                  (EIS) Collaboration. Wiedmann et al. Stroke. 2012;43:00-
                                                                                                                                                                                                                                                                                                                                                  00.
                                                                                                                                                                                                                                                                                                                                                                                                                                                     - 1 prospective study: K. J. Ottenbacher, J. E. Graham, A. J. Ottenbacher, J. Lee, S. Al Snih, A.
                                                             Discharge                                                                                                                                                                                                                                                                            NHS UK/Royal College of Physicians website: Sentinel                                               Karmarkar, T. Reistetter, and G. V. Ostir. Hospital Readmission in Persons With Stroke Following                                NHS UK/Royal College of       National Sentinel Stroke
28. Mood assessment                                                                  Mood assessed by discharge                                                                                                                                                                                                                                                                                                UK                                                                                                                                                        C
                                                                                                                                                                                                                                                                                                                                                  Stroke Audit                                                                                       Postacute Inpatient Rehabilitation. J Gerontol A Biol Sci Med Sci Received September 14, 2011;                                  Physicians                    Clinical Audit
                                                                                                                                                                                                                                                                                                                                                                                                                                                     Accepted December 8, 2011. (2++)
QI                          Stroke patient type




Mortality

                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who have undergone
                            tracheostomy tube placement and received
                            speech and language intervention


                            Stroke patients who received speech and
Improvement on speech and   language intervention
language
                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention


                            Stroke patients who received speech and
                            language intervention
Dependency                       All




Quality of life at 3 month       All


Hospital-acquired pneumonia
rate for ischemic stroke patients Ischemic
Definition



Stroke death rates for 7-day in-hospital stroke fatality; 30 day all cause mortality; one year all cause
mortality, for patients with ischemic stroke, intracerebral hemorrhagic stroke, subarachnoid
hemorrhage, and transient ischemic attack
proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Augmentative-Alternative Communication Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)


proportion of stroke patients in each risk-adjusted group that make at least one level of progress on
the Fluency Functional Communication Measure (FCM)
Percentage of patients dependent in transfer from bed to chair (Barthel Index Item “Transfer” 0–10
within first 24 hours after admission) who are mobilized within the first 2 days after admission.
Patients with TIA or increased intracranial pressure or disturbances of consciousness are excluded.


Probability of patients treated in a specific hospital for good quality of life (measured with validated
instrumental scales, e.g. SF-36 at three months) three months after stroke in comparison to all
hospitals. Patients treated in hospitals with follow-up rate <75% are excluded.


Probability of ischemic stroke patients to acquire new pneumonia during stay in a specific hospital in
comparison to all hospitals adjusted for age, sex, stroke severity and artificial respiration.
Denominator




Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients who have undergone tracheostomy tube placement, ages 16 years and older, with a treatment plan
recommending speech and language intervention for a minimum of two sessions. Patients must receive speech and language
intervention using either an individual and/or group treatment model or a training and/or consultation model.


Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
Stroke patients, ages 16 years and older, with a treatment plan recommending speech and language intervention for a
minimum of two sessions. Patients must receive speech and language intervention using either an individual and/or group
treatment model or a training and/or consultation model
All stroke patients. Patients with TIA or increased intracranial pressure or disturbances of consciousness are excluded.




All stroke patients. Patients treated in hospitals with follow-up rate <75% are excluded.



ischemic stroke patients
Numerator                                                              Performance goal




The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Alaryngeal Communication
Functional Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Fluency Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Pragmatics Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Problem Solving Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Reading Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Voice Following Tracheostomy
Functional Communication Measure (FCM)


The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Voice Functional Communication
Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Attention Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Memory Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Motor Speech Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Spoken Language Comprehension
Functional Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Spoken Language Expression
Functional Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Swallowing Functional
Communication Measure (FCM)
The number of stroke patients in each risk-adjusted group that make
at least one level of progress on the Writing Functional
Communication Measure (FCM)
patients dependent in transfer from bed to chair (Barthel Index Item
“Transfer” 0–10 within first 24 hours after admission) who are
mobilized within the first 2 days after admission. Patients with TIA or
increased intracranial pressure or disturbances of consciousness are
excluded.

patients treated in a specific hospital for good quality of life
(measured with validated instrumental scales, e.g. SF-36 at three
months) three months after stroke in comparison to all hospitals.
Patients treated in hospitals with follow-up rate <75% are excluded.



ischemic stroke patients to acquire new pneumonia during stay
Origin




Canadian Stroke Strategy Core Performance Indicator Update 2010. CSS Information & Evaluation Working Group. June
2010.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.

National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.

National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
National Center for Evidence-Based Practice in Communication Disorders. National Outcomes Measurement System: Adults
in health care speech-language pathology user's guide. Rockville (MD): American Speech-Language-Hearing Association;
2003. 53 p.
Heuschmann et al. Development and Implementation of Evidence-Based Indicators for Measuring Quality of Acute Stroke
Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR). Stroke.
2006; 37: 2573-2551



Heuschmann et al. Development and Implementation of Evidence-Based Indicators for Measuring Quality of Acute Stroke
Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR). Stroke.
2006; 37: 2573-2551
Heuschmann et al. Development and Implementation of Evidence-Based Indicators for Measuring Quality of Acute Stroke
Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR). Stroke.
Country   Evidence base




Canada    Based on Consensus Review Panel Held December 2012
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
          Communication Disorders. National Outcomes
US        Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
          American Speech-Language-Hearing Association; 2003.
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
           - National Center for Evidence-Based Practice in
US        Communication Disorders. National Outcomes
          Measurement System: Adults in health care speech-
          language pathology user's guide. Rockville (MD):
Germany   Unknown




Germany   Unknown



Germany   Unknown
Database                         Used for



                                 Accreditation Canada:
Canadian Best Practice           Stroke Services -
Recommendation for Stroke Care   mandatory indicator

National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse


National Quality Measures
Clearinghouse
QI                                                Stroke patient type



Stroke/TIA register                               All


Participation of the hospital in training of
emergency medical services in stroke              All


Participation of the hospital in stroke education
campaigns of the population                       All


Implementation of a multidisciplinary Stroke
Team in the hospital                              All

24 h availability of brain imaging including
radiological expertise in ‘stroke imaging’ in the
hospital                                          All


Implementation of an internal and external
quality management system in the hospital         All


Availability of vascular imaging and of
diagnostic cardiologic methods at the hospital    All


Availability of biological monitoring in the
hospital                                          All

                                                  Ischemic



                                                  All

Documentation & risk assessment

                                                  All



                                                  All




New stroke events                                 All



Stroke admission (ER)                             All



Stroke admission (inpatient)                      All



Readmission rate                                  All
Length of stay (stroke unit)    All



Discharge destination (acute)   All
Definition



the practice can produce a register of patients with stroke or TIA

Participation of hospital staff in training of emergency medical
services in stroke. Training could be performed in cooperation with
other hospitals. Training should be performed at least once a year.


Participation of the hospital in stroke education campaigns of the
population
Implementation of a multidisciplinary Stroke Team in the hospital. A
multidisciplinary stroke team is defined as daily presence of
physician, nurse and physiotherapist, presence of speech therapist,
occupational therapist and social service if required and 24 hours
24 hours availability of brain imaging including radiological expertise
in ‘stroke imaging’ in the hospital. Radiological expertise in ‘stroke
imaging’ is defined as a physician with experience in interpretation
of CT/MRI (at least 6 months training in neuroradiological
Existence of an internal system for quality management in the
hospital, including continuous evaluation of operational procedures
and workflow in the hospital, and participation of the hospital in a
standardized project for external comparison of quality of care
Availability of vascular imaging (defined as diagnostic facilities to
examine cerebral arteries including extracranial carotid arteries
using ultrasound [Doppler or Duplex] or angiographic methods [CT-,
MR- or DS-angiography] and of diagnostic cardiologic methods at

Availability of biological monitoring in the hospital to monitor basic
vital parameters including blood pressure, heart rate, body
temperature and oxygen saturation.
Percent of patients with ischemic stroke on arrival with NIH Stroke
Scale score documented in the medical record by the end of
hospital day 2

Conformity scoring for the content of the patient's dossier treated
for stroke



Documented pre-morbid function



Documentation of smoking history




age-standardized rate of new stroke events admitted to an acute
care hospital, per 100,000 population age 20 and older
The emergency department admission volumes for patients with
ischemic stroke, intracerebral hemorrhagic stroke, subarachnoid
hemorrhage, and transient ischemic attack.

The hospital inpatient admission volumes for patients with ischemic
stroke, intracerebral
hemorrhagic stroke, subarachnoid hemorrhage, and transient
ischemic attack.

Proportion of acute stroke and TIA patients that are discharged alive
that are then readmitted to hospital with a new stroke or TIA
diagnosis within 90 days of index acute care discharge (since 2010)
Median total time spent on a stroke unit for each patient during
inpatient stay (since 2010)
Distribution of discharge locations (dispositions) for acute stroke
patients from acute inpatient care to: home (with and without
services); inpatient rehabilitation (General or specialized); long term
care; and to palliative care (each stratified by stroke type and
Denominator

This measure applies to practices whose patient population includes
individuals with a diagnosis of stroke or transient ischaemic attack (TIA)
(one practice at a time).




Patients with ischemic stroke



Number of items evaluated for each dossier




Total mid-year population age 20 and older
Numerator                                                          Performance goal


The practice can produce a register of patients with stroke or
transient ischaemic attack (TIA)




Patients with documentation of NIH Stroke Scale score by the end
of hospital day 2


Number of conformed items for each dossier




Total number of new stroke events for persons age 20 and older
Origin

British Medical Association (BMA) and NHS Employers. Quality and outcomes
framework guidance for GMS contract 2009/10. London (UK): British Medical
Association, National Health Service Confederation; 2009 Mar. 162 p.

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

Heuschmann et al. Development and Implementation of Evidence-Based Indicators
for Measuring Quality of Acute Stroke Care
The Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

United States Department of Veterans Affairs, 2009

HAS: Présentation du thème « Prise en charge initiale de l’accident vasculaire
cérébral » Available at: http://www.has-
sante.fr/portail/upload/docs/application/pdf/2012-
03/ipaqss_fiche_avc_20120309.pdf
Systematic review of process indicators: including early rehabilitation interventions
used to measure quality of acute stroke care. Purvis et al. International Journal of
Stroke Vol 4, April 2009, 72–80

Systematic review of process indicators: including early rehabilitation interventions
used to measure quality of acute stroke care. Purvis et al. International Journal of
Stroke Vol 4, April 2009, 72–80

Canadian Institute for Health Information (CIHI). Health indicators 2010: definitions,
data sources and rationale. Ottawa (ON): Canadian Institute for Health Information
(CIHI); 2010 May. 47 p.


Canadian Stroke Strategy Core Performance Indicator Update 2010. CSS Information
& Evaluation Working Group. June 2010.


Canadian Stroke Strategy Core Performance Indicator Update 2010. CSS Information
& Evaluation Working Group. June 2010.


Canadian Stroke Strategy Core Performance Indicator Update 2010. CSS Information
& Evaluation Working Group. June 2010.
Canadian Stroke Strategy Core Performance Indicator Update 2010. CSS Information
& Evaluation Working Group. June 2010.


Canadian Stroke Strategy Core Performance Indicator Update 2010. CSS Information
& Evaluation Working Group. June 2010.
Country             Evidence base
                    British Medical Association (BMA) and NHS Employers.
                    Quality and outcomes framework guidance for GMS
                    contract 2009/10. London (UK): British Medical
UK                  Association, National Health Service Confederation; 2009
                     - 1 systematic review: Langhorne P, Pollock Aon behalf
                    of The Stroke Unit Trialists’ Collaboration. What are the
                    components of effective stroke unit care? Age Aging
Germany             2002; 31:365–71 (1++)



Germany             Unknown
                     - 1 systematic review: Langhorne P, Pollock Aon behalf
                    of The Stroke Unit Trialists’ Collaboration. What are the
                    components of effective stroke unit care? Age Aging
Germany             2002; 31:365–71 (1++)



Germany             Unknown



Germany             Unknown



Germany             Unknown



Germany             Unknown

US



France               - 1 prospective study: Cadilhac D, Ibrahim J, Pearce D et
                    al. Multicentre comparison of process of care between
                    stroke units and conventional care wards in Australia.
                    Stroke 2004; 35:1035–40. (2++)
Various countries
                     - 2 clinical guidelines: VA-DoD (US), HAS (France)



Various countries




Canada              Unknown


                    Based on Consensus Review Panel Held December 2009
Canada              (4)


                    Based on Consensus Review Panel Held December 2009
Canada              (4)


                    Based on Consensus Review Panel Held December 2009
Canada              (4)
         Based on Consensus Review Panel Held December 2009
Canada   (4)


         Based on Consensus Review Panel Held December 2009
Canada   (4)
Grade of
                 Database                                  Used for
recommendation
                 National Quality Measures
                 Clearinghouse
D



A



D



A



D



D



D



D

                 Quality      Enhancement       Research
                 Initiative


                 HAS, Haute Autorité de Santé

C




                 National Quality Measures
                 Clearinghouse
D


                 Canadian Best Practice
D                Recommendation for Stroke Care


                 Canadian Best Practice
D                Recommendation for Stroke Care

                                                           Accreditation Canada:
                 Canadian Best Practice                    Stroke Services - mandatory
D                Recommendation for Stroke Care            indicator
    Canadian Best Practice
D   Recommendation for Stroke Care

                                     Accreditation Canada:
    Canadian Best Practice           Stroke Services - mandatory
D   Recommendation for Stroke Care   indicator
Annex B: Key to evidence statements and grades of recommendations

Levels of evidence

1++        High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+         Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias
1-         Meta-analyses, systematic reviews, or RCTs with a high risk of bias
2++        High quality systematic reviews of case control or cohort or studies
           High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal
2+         Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal
2-         Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
3          Non-analytic studies, e.g. case reports, case series
4          Expert opinion


Grades of recommendations


           At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or
           A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results


           A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or
           Extrapolated evidence from studies rated as 1++ or 1+


           A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or
           Extrapolated evidence from studies rated as 2++


           Evidence level 3 or 4; or
           Extrapolated evidence from studies rated as 2+
Title
Author

Publisher
Publication Date
Copyrights




Contact
Full data extraction sheet 7.1_supplement
Dominik Michiels (UZ Leuven), Ying Sun (Deloitte), Vincent Thijs (UZ Leuven), Omer Saka Rasit (Deloitte), Dimitri
Hemelsoet (UZ Gent), Marijke Eyssen (KCE), Dominique Paulus (KCE)
KCE - Belgian Health Care Knowledge Centre
6/29/2012
KCE reports are published under a “by/nc/nd” Creative Commons Licence
http://kce.fgov.be/content/about-copyrights-for-kce-reports.

Michiels D, Sun Y, Thijs V, Saka Rasit O, Hemelsoet D, Eyssen M, Paulus D. Stroke units: efficacy, quality indicators
and organisation Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE). 2012.
This document is available on the website of the Belgian Health Care Knowledge Centre
KCE - Federaal Kenniscentrum voor de gezondheidszorg - Centre fédéral d’expertise des soins de santé – Belgian
Health Care Knowlegde Centre.
Centre Administratif Botanique, Doorbuilding (10th floor)
Boulevard du Jardin Botanique 55
B-1000 Brussels
Belgium
Tel: +32 [0]2 287 33 88
Fax: +32 [0]2 287 33 85
Email : info@kce.fgov.be
Web : http://www.kce.fgov.be

				
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