Defect free acute inpatient ischemic stroke measure bundle
Measure bundle purpose: Ensure patients receive optimal acute inpatient care.
The numerator has three components, all of which must be met:
*See measure specifications for complete definitions.
- Antithrombotic therapy* received by end of hospital day two OR documentation of medical/patient exception
- Antithrombotic therapy prescribed* at discharge
- Appropriate antithrombotic for patients with stroke AND non valvularatrial fibrillation using therapeutic anticoagulation (warfarin, LMWH or direct factor inhibitors as approved by FDA), OR documentation of medical/patient exception,
- Appropriate antithrombotic for patients with stroke AND mechanical heart valve or valvular atrial fibrillation using anticoagulation with warfarin OR documentation of medical/patient exception, OR
- Appropriate antithrombotic for all other patients with stroke using antiplatelet or therapeutic anticoagulation
Patients with ischemic stroke who have documentation of active smoking status* OR former smoker with quit date less than 1 year from time of assessment provided counseling on the bad effects of tobacco, the benefit of quitting AND at least one of the following:
- Referral back to PCP for tobacco cessation support, AND/OR
- Referral to tobacco cessation clinic or tobacco-dependent telephone quitline, AND/OR
- Prescription of tobacco dependence medications including nicotine replacement therapies products, bupropion SR or Varenicline, or any FDA-approved drugs for tobacco dependence therapies or referral to PCP
is divided by
the denominator: All acute ischemic stroke and transient ischemic attack patients aged 18 years and older admitted for inpatient care.
Exclusions are removed from the denominator:
For all components:
- Patients discharged to hospice
- Patients who were placed on comfort measures by end of hospital day two
- Patient died by end of hospital day two.
- Patient enrolled in a clinical trial
- Patient declines treatment or discharged against medical advice by end of hospital day two.
- Patients with documented contraindication to specific intervention.
Key Phrases
Examples of key phrases you could use to meet the measure include:
- early antithrombotic therapy prescribed
- antithrombotic therapy prescribed at discharge
- Patient is not an active smoker
- Patient counseled on risks of smoking, benefits of quitting, and referred to tobacco cessation supports
Measure Calculation Example
This measure utilizes an all-or-none calculation strategy.
Dr. Zhang treats 5 patients (A, B, C, D, and E) between January 1 and December 31 that were diagnosed with acute ischemic stroke or transient ischemic attach aged 18 years and older while they were admitted for inpatient care.
- All five patients A, B, C, D, and E had documentation of a prescription for an early anthrombotic.
- Four patients A, B, D, and E were discharged with a prescription for antithrombotic therapy. C did not.
- All five patients A, B, C, D, and E had documentation they were either a non-smoker for greater than 1 year or tobacco use management if an active smoker.
Dr. Zhang's performance rate is 80% for this measure. 4 patients (A, B, D, E) met the bundle/5 patients in the denominator.