Specifications of evidence-based performance measures
Performance measures of ischaemic stroke care | Definition of performance measures for eligible patients* |
Acute performance measures | |
Intravenous rt-PA <2 hours | Intravenous recombinant tissue plasminogen activator (rt-PA) in patients who arrived within 2 hours after initial symptom onset and treated within 3 hours. |
Early antithrombotics | Antithrombotic therapy prescribed within 48 hours of hospitalisation, including antiplatelet or anticoagulant therapy. |
DVT prophylaxis | Patients at risk for deep vein thrombosis (DVT) (non-ambulatory) who received DVT prophylaxis by end of hospital day 2, including pneumatic compression, warfarin sodium or heparin sodium. |
Performance measures at discharge | |
Discharge antithrombotics | Antithrombotic therapy prescribed at discharge. |
Anticoagulation for atrial fibrillation | Anticoagulation prescribed at discharge for patients with atrial fibrillation or atrial flutter documented during hospitalisation. |
LDL 100 | Lipid-lowering agent prescribed at discharge if low-density lipoprotein (LDL) ≥100 mg/dL. |
Antihypertensive therapy for hypertension | Antihypertension medication prescribed at discharge for patients with a history of hypertension or hypertension documented during hospitalisation. |
Hypoglycaemic therapy for diabetes mellitus | Hypoglycaemic medication prescribed at discharge for patients with a history of diabetes mellitus or diabetes mellitus documented during hospitalisation. |
Smoking cessation | Smoking cessation intervention (counselling or medication) prior to discharge for current or recent smokers. |
*Eligible patients were those without any medical contraindications (eg, treatment intolerance, excessive risk of adverse reaction, patient/family refusal or terminal illness/comfort care only) and documented as reasons for non-treatment for each of the applicable measures. We also excluded patients who were discharged to hospice, or another short-term general hospital, or against medical advice before the end of hospital day 2. For acute performance measures except for rt-PA measure, we excluded patients who died before the end of hospital day 2. For the acute rt-PA measure, we excluded patients with missing or erroneous onset, arrival or treatment times, those who began intravenous tissue-type plasminogen activator (t-PA) at an outside hospital, or who initiated intravenous t-PA after 180 min from onset. For performance measures at discharge, we excluded patients who died during hospitalisation. As for seven performance measures from the Get With The Guideline-Stroke (GWTG-Stroke), we employed the same criteria as the GWTG-Stroke.