Patient/Caregiver nutritional preference

Measure purpose: Ensure patients and their surrogate decision makers are engaged in shared decision making prior to gastrostomy tube placement.

The numerator: Patients for whom there is documentation of shared decision making with the patient or the patient’s surrogate decision maker, before the procedure was completed, that included discussion of at least two forms of providing nutrition, one of which is oral/natural nutrition

is divided by

the denominator: all patients aged 18 years and older with a primary diagnosis of acute ischemic stroke and intracranial hemorrhage who have had gastrostomy tube placed during the acute inpatient stay for the treatment of ischemic or hemorrhagic stroke

Exclusions are removed from the denominator:

• Patients with gastrostomy tube prior to admission

Key Phrases

Examples of key phrases you could use to meet the measure include:

• Engaged patient and care partners in shared decision making prior to gastrostomy tube placement
• Discussed alternate forms of providing nutrition, solicited patient values, and provided informed consent prior to gastrostomy tube placement. 

Measure Calculation Example

Dr. Watanabe treated 25 patients aged 18 years and older with a primary diagnosis of acute ischemic stroke and intracranial hemorrhage who had a gastrostomy tube placed during the acute inpatient stay for a diagnosis of ischemic or hemorrhagic stroke between January 1 and December 31. This is the denominator. None of the 25 patients met the exclusion criteria. 

Of the 25 patients, Dr. Watanabe documented shared decision making before the gastrostomy tube was placed that included a discussion of at least two forms of providing nutrition of which one was natural for 11 patients.

Quality of patient care = 11/25. Dr. Watanabe has a score of 44% for this measure.