Table e-1. VHA Quality Indicators for Care of Inpatient Ischemic Stroke
Process of Care* / Brief DescriptionEarly Hospitalization (Emergency Department)
Thrombolysis / Percent of patients with acute ischemic stroke who arrive at the VAMC within two hours of symptom onset for whom intravenous (IV) thrombolysis with tPA was initiated at that hospital within three hours of symptom onset(or documented reason why not). No exclusion by CMO.
Dysphagia screening / Percent of patients with ischemic stroke with dysphagia screening prior to oral intake, where the screen indicates that the patient is able to take food, fluids, or medication by mouth(or documented reason why not). Subjects CMO anytime during hospital stay excluded.
NIH Stroke Scale HD2 / Percent of patients with ischemic stroke with stroke severity documented with an NIH Stroke Scale (NIHSS) score by the end of hospital day 2. Subjects CMO before HD2 excluded.
In-Hospital Period
Antithrombotic therapy HD2 / Percent of patients who received antithrombotic therapy (including antiplatelet or anticoagulant medications) by the end of hospital day two (or documented reason why not). Subjects CMO before HD2 excluded.
DVT prophylaxis HD2 / Percent of non-ambulatory patients receiving venous thromboembolism prophylaxis (pharmacologic or mechanical) by the end of hospital day 2. Subjects CMO before HD2 excluded.
Early ambulation HD2 / Percent of patients who are ambulatory by the end of hospital day 2. Subjects CMO before HD2 excluded.
Fall risk assessment HD2 / Percent of patients who had fall risk assessment using the Morse Fall Scale by the end of hospital day 2. No exclusion by CMO.
Pressure ulcer risk assessment / Percent of patients who had pressure ulcer assessment documented with a Braden Scale within 24 hours before or after admission. No exclusion by CMO.
Rehabilitation/FIM / Percent of patients with documentation of a functional independence measure (FIM) score to assess the need for rehabilitation. No exclusion by CMO.
Discharge*
Antithrombotic therapy / Percent of patients prescribed antithrombotic therapy (including antiplatelet or anticoagulant medications) at discharge(or documented reason why not). Subjects CMO anytime during hospital stay excluded.
Atrial fibrillation management / Percent of patients with atrial fibrillation who are discharged on anticoagulation therapy(or documented reason why not). Subjects CMO anytime during hospital stay excluded.
Lipid management / Percent of patients with LDL ≥100 mg/dl, or LDL not measured, or on cholesterol lowering medication prior to admission, who are discharged on cholesterol reducing drugs(or documented reason why not). Subjects CMO anytime during hospital stay excluded.
Smoking cessation counseling / Percent of patients and a history of smoking cigarettes who are, or whose caregivers are, given smoking cessation counseling during the hospital stay(or documented reason why not). Subjects CMO anytime during hospital stay excluded.
Stroke education / Percent of patients, or their caregiver(s), who were given education or educational materials during the hospital stay addressing all of the following: personal risk factors for stroke, warning signs and symptoms of stroke, activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge(or documented reason why not). Applied only to patients discharged home. Subjects CMO anytime during hospital stay excluded.
Key: CMO= Comfort measures only; HD2 = Hospital day 2 (equal to the day after admission).
* The following exclusions were applied to all discharge-related quality measures: discharged to another short-term hospital, transferred to another acute care facility, left against medical advice, or discharged to hospice.