Last Updated: Version 3.

2 NQF ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Information Form Collected For: The Joint Commission Only CMS Informational Only Measure Set: Stroke (STK) Measure ID: STK-2 Performance Measure Name: Discharged on Antithrombotic Therapy Description: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge Rationale: The effectiveness of antithrombotic agents in reducing stroke mortality, strokerelated 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 prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. Warfarin is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA. Type of Measure: Process Improvement Noted As: An increase in rate Numerator Statement: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge Included Populations: Not applicable Excluded Populations: None Data Elements: Antithrombotic Therapy Prescribed at Discharge Denominator Statement: Ischemic stroke patients
Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)

STK-2-1

Included Populations: Discharges with an ICD-9-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1. Excluded Populations: Patients less than 18 years of age Patients who have a Length of Stay greater than 120 days Patients with Comfort Measures Only documented Patients enrolled in clinical trials Patients admitted for Elective Carotid Intervention Patients discharged/transferred to another hospital for inpatient care Patients who left against medical advice or discontinued care Patients who expired Patients discharged/transferred to a federal health care facility Patients discharged/transferred to hospice Patients with a documented Reason For Not Prescribing Antithrombotic Therapy at Discharge Data Elements: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Status Elective Carotid Intervention ICD-9-CM Principal Diagnosis Code Reason For Not Prescribing Antithrombotic Therapy at Discharge Risk Adjustment: No Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency. Measure Analysis Suggestions: None Sampling: Yes, please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section. Data Reported As: Aggregate rate generated from count data reported as a proportion

Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)

STK-2-2

Selected References: 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. Adams H, Adams R, Del Zoppo G, Goldstein LB. Guidelines for the Early Management of Patients With Ischemic Stroke: Guidelines Update A Scientific Statement From the Stroke Council of the American Heart Association/American Stroke Association. Stroke Vol. 36, 2005: 916:923. Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke. Chest Vol. 119, 2001: 300-320. Brott TG, Clark WM, Grotta JC, et al. Stroke the first hours. Guidelines for acute treatment. Consensus Statement. National Stroke Association. 2000. Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40,000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups, Stroke 2000;31:1240-1249. Coull BM, Williams LS, Goldstein LB, et al. Anticoagulants and Antiplatelet Agents in Acute Ischemic Stroke. Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association) Stroke. 2002;33:1934 1942. Guideline on the Use of Aspirin as Secondary Prophylaxis for Vascular Disease in Primary Care, Centre for Health Services Research University of Newcastle upon Tyne, & Centre for Health Economics of York, 1998. 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.

Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)

STK-2-3

STK-2: Discharged on Antithrombotic Therapy

Numerator: Denominator: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge
Ischemic stroke patients.
START

Run cases that are included in the Stroke Initial Patient Population and pass the edits defined in the Transmission Data Processing Flow: Clinical through this measure.

ICD-9-CM Principal Diagnosis Code

Not on Table 8.1

On Table 8.1

Discharge Status

= 02, 07, 20, 43, 50, 51, 66

= 01, 03, 04, 05, 06, 21, 61, 62, 63, 64, 65, 70

Missing

Comfort Measures Only

= 1, 2, 3

=4

Missing

Clinical Trial

=Y

=N

Missing

Elective Carotid Intervention

=Y

=N

Missing

Antithrombotic Therapy Prescribed At Discharge

=Y

In Numerator Population

E
STK-2 Z

=N

Case Will Be Rejected

Missing

Reason for Not Prescribing Antithrombotic Therapy at Discharge

=Y

Not In Measure Population

=N

In Measure Population STK-2 Z

D
Stop

Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)

STK-2-4

STK-2: Discharged on Antithrombotic Therapy Numerator: Denominator: 1. Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge. Ischemic stroke patients.

Start processing. Run cases that are included in the Stroke (STK) Initial Patient Population and pass the edits defined in the Transmission Data Processing Flow: Clinical through this measure. Check ICD-9-CM Principal Diagnosis Code a. If the ICD-9-CM Principal Diagnosis Code is not on Table 8.1, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing. b. If the ICD-9-CM Principal Diagnosis Code is on Table 8.1, continue processing and proceed to Discharge Status. Check Discharge Status a. If Discharge Status equals 02, 07, 20, 43, 50, 51, or 66, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing. b. If Discharge Status equals 01, 03, 04, 05, 06, 21, 61, 62, 63, 64, 65, or 70, continue processing and proceed to Comfort Measures Only. Check Comfort Measures Only a. If Comfort Measures Only is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing. b. If Comfort Measures Only equals 1, 2, or 3, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing. c. If Comfort Measures Only equals 4, continue processing and proceed to Clinical Trial. Check Clinical Trial a. If Clinical Trial is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing. b. If Clinical Trial equals Yes, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing. c. If Clinical Trial equals No, continue processing and proceed to Elective Carotid Intervention.

2.

3.

4.

5.

Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)

STK-2-5

6.

Check admitted for Elective Carotid Intervention a. If Elective Carotid Intervention is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing. b. If Elective Carotid Intervention equals Yes, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing. c. If Elective Carotid Intervention equals No, continue processing and proceed to Antithrombotic Therapy Prescribed at Discharge. Check Antithrombotic Therapy Prescribed at Discharge a. If Antithrombotic Therapy Prescribed at Discharge is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing. b. If Antithrombotic Therapy Prescribed at Discharge equals Yes, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Stop processing. c. If Antithrombotic Therapy Prescribed at Discharge equals No, continue processing and check Reason for Not Prescribing Antithrombotic Therapy at Discharge. Check Reason for Not Prescribing Antithrombotic Therapy at Discharge a. If Reason for Not Prescribing Antithrombotic Therapy at Discharge is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing. b. If Reason for Not Prescribing Antithrombotic Therapy at Discharge equals Yes, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing. c. If Reason for Not Prescribing Antithrombotic Therapy at Discharge equals No, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.

7.

8.

Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)

STK-2-6