eMeasure Title Thrombolytic Therapy
eMeasure Identifier
(Measure Authoring Tool)
91 eMeasure Version number 2
NQF Number 0437 GUID 2838875a-07b5-4bf0-be04-c3eb99f53975
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Joint Commission
Measure Developer Joint Commission
Endorsed By National Quality Forum
Description
Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well.
Copyright
Measure specifications are in the Public Domain.

LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The administration of thrombolytic agents to carefully screened, eligible patients with acute ischemic stroke has been shown to be beneficial in several clinical trials. These included two positive randomized controlled trials in the United States: The National Institute of Neurological Disorders and Stroke (NINDS) Studies, Part I and Part II. Based on the results of these studies, the Food and Drug Administration approved the use of intravenous recombinant tissue plasminogen activator (IV r-TPA or t-PA) for the treatment of acute ischemic stroke when given within 3 hours of stroke symptom onset. A large meta-analysis controlling for factors associated with stroke outcome confirmed the benefit of IV t-PA in patients treated within 3 hours of symptom onset. While controversy still exists among some specialists, the major society practice guidelines developed in the United States all recommend the use of IV t-PA for eligible patients. Physicians with experience and skill in stroke management and the interpretation of CT scans should supervise treatment.
Clinical Recommendation Statement
The administration of thrombolytic agents to carefully screened, eligible patients with acute ischemic stroke has been shown to be beneficial in several clinical trials. Intravenous recombinant tissue plasminogen activator (IV r-TPA or t-PA) should be used for the treatment of acute ischemic stroke when given within 3 hours of stroke symptom onset.
Improvement Notation
An increase in the rate
Reference
Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks E. Guidelines for the Early Management of Adults with Ischemic Stroke: A Guideline From the American Heart Association/American Stroke, Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke. 2007;38:1655-1711.
Reference
Adams H, Adams R, Del Zoppo G, Goldstein LB. American Heart Association/American Stroke Association Guidelines Update A Scientific Statement From the Stroke Council of the Guidelines for the Early Management of Patients With Ischemic Stroke: 2005, Stroke.2005;36;916-923.
Reference
Antithrombotic and Thrombolytic Therapy for Ischemic Stroke The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Gregory W. Albers, MD, Chair; Pierre Amarenco, MD; J. Donald Easton, MD; Ralph L. Sacco, MD; and Philip Teal, MD (CHEST 2004; 126:483S–512S).
Reference
del Zoppo GJ, Saver JL, Jauch EC, Adams HP. Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator: A Science Advisory From the American Heart Association/ American Stroke Association. Stroke. 2009;40:2945-2948.
Reference
Diagnosis and Initial Treatment of Ischemic Stroke, Institute for Clinical Systems Improvement (ICSI), 2001.
Reference
Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Gidetti D, et. al. Thrombolysis with Alteplase 3 to 4.5 hours after acute ischemic stroke. The European Cooperative Acute Stroke Study (ECASS) Investigators. NEJM. 2008;359(13):1317-29.
Reference
Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995;274:1017-1025.
Reference
Management of Patients with Stroke. Assessment, investigation, immediate management and secondary prevention, Scottish Intercollegiate Guidelines Network, 1997.
Reference
Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley EC, Lewandowski CA, Kwiatkowski TP. Early stroke treatment associated with better outcome The NINDS rt-PA Stroke Study. Neurology 2000;55: 1649-1655.
Reference
Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention. Stroke. Vol. 37, 2006:577.
Reference
STROKE the First Hours Guidelines for Acute Treatment, National Stroke Association, 2000.
Reference
The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators. Association of Outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke Trials. Lancet 2004;363:768-774.
Reference
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. New England Journal of Medicine 1995;333:1581-1587.
Definition
None
Guidance
The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

The facility location arrival datetime and facility location departure datetime are coupled with the emergency department visit value set. They intend to represent arrival date/time at the emergency department and the discharge date/time from the emergency department, respectively.

The baseline state data value set and its associated stop date/time intend to capture the date and time prior to hospital arrival at which it was witnessed or reported that the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health
Transmission Format
None
Initial Patient Population
Patients admitted to the hospital for inpatient acute care with a Principal Diagnosis Code for ischemic or hemorrhagic stroke with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission.
Denominator
Acute ischemic stroke patients whose time of arrival is within 2 hours (less than or equal to 120 minutes) of time last known well.
Denominator Exclusions
Patients admitted for Elective Carotid Intervention, or
Patients with a documented Reason For Not Initiating IV Thrombolytic
Numerator
Acute ischemic stroke patients for whom IV thrombolytic therapy was initiated at this hospital within 3 hours (less than or equal to 180 minutes) of time last known well.
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
eMeasure Stroke (eSTK)