Antithrombotic Therapy By End of Hospital Day 2

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

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The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.

Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist

Improvement noted as an increase in rate

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The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions. 

NPO is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e. rectal or intravenous).  

In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.

TBD

Inpatient hospitalization for patients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during measurement period

Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke

Inpatient hospitalizations for patients who have a duration of stay less than 2 days
Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival
Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization
Inpatient hospitalization for patients with an INR greater than 3.5

Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival

Not Applicable

Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival
Inpatient hospitalization for patients who receive Ticagrelor as an antithrombotic therapy the day of or day after hospital arrival

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

eMeasure Stroke (eSTK)