Crosswalk outcomes, measures and data sources

Paul Coverdell National Acute Stroke Program (PCNASP)

Cross Walk Showing Relationships among Short/Intermediate/Long-Term Outcome Measures, and Data Sources for Associated Performance Measures

DATA SOURCE1

Process Perfor-mance Measures3

Performance Measures for Pre-Hospital Quality of Care Source: Data Elements from Emergency Services

Performance Measures for In-Hospital Quality of Care Source: Data Elements from Hospital Records

Performance Measures for Post-Hospital Quality of Care Sources: Data Elements from Hospital Records and Community Care

Outcome and performance measures2, with Question #s

E 1

E 2

E3

Q1

Q2

Q3

Q4

Q5

Q6

Q7

Q 8

Q1

Q2

Q3

Q4

Q5

Q6

Q7

Q8

Q9

Q 10

Q 11

Q 12

Q 13

Q1

Q2

Q3

Q4

Q5

Q6

Q7

Q 8

Q9

Short Term Outcomes Measures (1-2 years)

S1. Increased public awareness of signs and symptoms of stroke and knowledge of appropriate activation of emergency medical systems

X

X

S2. Maintenance of existing broad reach and/or increase in the state-wide reach of the stroke system of care

X

S3. Increased data usage and sharing between components of the stroke care system that will result from having an integrated/ linked data platform for pre-hospital data, in-hospital data, and early post-discharge data

X

X

S3a. Improved reliability and validity of data as determined through annual data validation of select and highly important data elements

X

S4. Increased workforce capacity and scientific knowledge for stroke surveillance within stroke systems of care

X

S4a. Increased implementation of quality improvement (QI) strategies for acute stroke care across the continuum of stroke care

X

S4b. Increased efficiencies and effectiveness of pre-hospital, in-hospital, and post-hospital stroke care practices and resources

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

S4c. Increased pre-notification of hospitals by EMS of suspected stroke patients.

X

S5. Improved patient and caregiver receipt of education on ongoing post-stroke care needs

X

X

Intermediate Outcome Measures (3+ Years)

I1. Reduced time to treatment for acute stroke events

X

X

X

X

I2. Improved transition of care from emergency services to hospital emergency department (ED)

X

X

X

X

X

X

X

X

X

I3. Improved transition of care from hospital to home, which may include reintegration with primary care provider, access to community resources, enhanced patient/caregiver education, and ongoing rehabilitation and secondary prevention

X

X

X

X

X

X

X

X

I4. Improved quality of EMS care for possible stroke patients

X

X

X

X

X

X

X

X

X

I5. Improved quality of acute and sub-acute ED and hospital stroke care as measured by adherence to established guidelines for care and quality metrics

X

X

X

X

X

X

X

X

X

X

X

X

X

X

I6. Improved defect free care for acute stroke patients

X

X

X

X

X

X

X

X

X

X

X

X

X

X

I7. Improved tobacco control/reduction in smoking post stroke

X

I8. Improved medication adherence post-discharge

X

X

I9. Reduced 30-day hospital readmissions and ED visits for stroke-related complications after stroke

X

X

X

I10. Reduced 30-day mortality after acute stroke

X

X

Long Term Outcome Measures

L1. Reduced disparities in stroke care, death, and disability should result from adherence to stroke care guidelines

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

¹ Data sources may contribute to short and/or intermediate and/or long-term performance measures. Additionally, hospital inventory data elements (attachments 4a and 4b) are used across patient-level measures for stratification on size and capacity

²See the process and quality of care performance measure reference numbers in the table below

³Process measures are reported in awardees’ annual performance report (APR), unless otherwise noted in this table

Process Performance Measures
E1	Process-level performance measures, which include public awareness, partnerships, recruitment, data infrastructure, data use, quality improvement, and sustainability
E2	Short-term outcome performance measures, which include public awareness, reach, data linkage, data reliability/validity, workforce capacity, stroke care, and patient education
E3	Intermediate outcome performance measures, which include systems of stroke care, stroke care, and health outcomes
Pre-Hospital Quality of Care Performance Measures (DRAFT)- derived from pre-hospital data elements (attachment 3a)
Q1	% of stroke transports with an on-scene time <15 minutes
Q2	% of stroke transports with a blood glucose checked and recorded
Q3	% of stroke transports where EMS called in a stroke alert pre-notification
Q4	% of stroke transports that had a stroke screen completed and recorded
Q5	% of stroke transports that had a documented time last known to be well
Q6	% of stroke transports that had a documented time of discovery
Q7	% of stroke transports that had a thrombolytic stroke check completed and documented
Q8	% of stroke transports where EMS diagnosis agreed with hospital diagnosis
In-Hospital Quality of Care Performance Measures- derived from in-hospital data elements (attachment 3b)
Q1	VTE prophylaxis provided by end of hospital day 2
Q2	Antithrombotic medication by end of hospital day 2
Q3	Antithrombotic medication at discharge
Q4	% of ischemic stroke patients that arrive by 2 hours of time last known well and are treated with IV tPA by 3 hours of last known well
Q5	Dysphagia screening performed and passed prior to food, fluids, or medication by mouth
Q6	Anticoagulation on discharge for patients with atrial fibrillation/flutter
Q7	Statin medication provided on discharge
Q8	Smoking cessation counseling and/or treatment provided
Q9	Assessed for rehabilitation needs
Q10	Stroke education: patients or caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke
Q11	% ischemic stroke patients with initial NIHSS score recorded
Q12	Median door-to-needle time
Q13	% patients with door-to-needle time <= 60 minutes
Post-Hospital Quality of Care (TOC) Performance Measures (DRAFT)- derived from post-hospital data elements (attachment 3c)
Q1	% of stroke patients discharged to home who have died by 30 days
Q2	% of stroke patients who were seen in ED within 30 days of discharge
Q3	% of stroke patients who were readmitted to the hospital within 30 days of discharge
Q4	% of stroke patients reporting blood pressure (BP) >140 systolic or >90 diastolic among those checking their BP at home
Q5	% of stroke patients checking the BP at home
Q6	% of stroke patients reporting 2 or more falls within 30 days of discharge
Q7	% of stroke patients who stopped taking medications since discharge
Q8	% of stroke transports where EMS diagnosis agreed with hospital diagnosis
Q9	% of stroke patients that had a follow-up appointment scheduled prior to discharge

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