Stroke is the third leading cause of death in the United States and a leading cause of severe long-term disability. Over 700,000 people will have a stroke this year; of these 200,000 will be recurrent strokes (AHA, 2006). Among all strokes, 88% are ischemic, 9% are intracranial hemorrhage, and 3% are subarachnoid hemorrhage (AHA, 2006). Recent data rank cerebrovascular disease among the 15 most costly medical conditions in the United States, which collectively accounted for one-half of the overall growth in health care spending between 1987 and 2000. The estimated direct and indirect cost of stroke alone for 2006 is $57.9 billion (AHA, 2006). A rise in treated prevalence accounted for most of the increased spending for cerebrovascular disease, rather than increased treatment costs per case (AHA, 2006). Nearly three–quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after the age of 55. Stroke death rates are higher for African Americans than for whites, even at younger ages (CDC).
In this project, NQF will identify and endorse measures that address the clinical, system and care coordination aspects involved in effective stroke care across the continuum of care. NQF is seeking a comprehensive set of measures that should include outcomes, as well as process measures with a documented relationship to outcomes. Special emphasis will be placed on the ability of the hospital to effectively coordinate care within its walls, including the emergency department, as well as with outside providers, including ambulatory care and skilled nursing facilities. Candidate measures may address a broad range of areas, including: stroke risk-assessment and prevention strategies, management of atrial fibrillation, surgical interventions such as carotid endarterectomy, recognition of early warning symptoms and timeliness of pre-hospital care, emergency department interventions, acute hospital care, post-acute care, rehabilitation, and ambulatory care. The project will consider measures for use at the individual clinician, group, health plan, and health system levels. Harmonization of similar measures, particularly across settings, will be apriority for this project.
The project will also focus on the prevention and management of stroke for various sub-populations as recommended in NQF’s report “National Voluntary Consensus Standards for Ambulatory Care: Performance Measures to Address Healthcare Disparities”.
The candidate measures will be considered for NQF endorsement as voluntary consensus standards. Agreement around the recommendations will be developed through NQF’s formal Consensus Development Process. This project, like all NQF activities, involves the active participation of representatives from across the spectrum of healthcare stakeholders and is guided by a Steering Committee.
Funding for this project has been provided by the Centers for Medicare & Medicaid Services.
For more information, contact Lisa Hines, BSN, MS, at 202.783.1300 or lhines@qualityforum.org.