Robert Wood Johnson Foundation, Clinical Scholars Program, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI.
Robert Wood Johnson Foundation, Clinical Scholars Program, University of Michigan, Ann Arbor, MI; Department of Neurology, University of Michigan Health System, Ann Arbor, MI; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI.
Ann Emerg Med. 2014 Sep;64(3):235-244.e5. doi: 10.1016/j.annemergmed.2014.01.034. Epub 2014 Mar 7.
Acute stroke is an important focus of quality improvement efforts. There are many organizations involved in quality measurement for acute stroke, and a complex landscape of quality measures exists. Our objective is to describe and evaluate existing US quality measures for the emergency care of acute ischemic stroke patients in the emergency department (ED) setting. We performed a systematic review of the literature to identify the existing quality measures for the emergency care of acute ischemic stroke. We then convened a panel of experts to appraise how well the measures satisfy the American College of Cardiology/American Heart Association (ACC/AHA) criteria for performance measure development (strength of the underlying evidence, clinical importance, magnitude of the relationship between performance and outcome, and cost-effectiveness). We identified 7 quality measures relevant to the emergency care of acute ischemic stroke that fall into 4 main categories: brain imaging, thrombolytic administration, dysphagia screening, and mortality. Three of the 7 measures met all 4 of the ACC/AHA evaluation criteria: brain imaging within 24 hours, thrombolytic therapy within 3 hours of symptom onset, and thrombolytic therapy within 60 minutes of hospital arrival. Measures not satisfying all evaluation criteria were brain imaging report within 45 minutes, consideration for thrombolytic therapy, dysphagia screening, and mortality rate. There remains room for improvement in the development and use of measures that reflect high-quality emergency care of acute ischemic stroke patients in the United States.
急性脑卒中是质量改进工作的重点。有许多组织参与急性脑卒中的质量测量，并且存在复杂的质量测量标准。我们的目标是描述和评估美国现有的用于急诊科急性缺血性脑卒中患者急救护理的质量指标。我们对文献进行了系统回顾，以确定现有的急性缺血性脑卒中急救护理质量指标。然后，我们召集了一个专家小组，评估这些措施在多大程度上满足美国心脏病学会/美国心脏协会（ACC/AHA）制定绩效衡量标准的标准（基础证据的强度、临床重要性、绩效与结果之间关系的大小以及成本效益）。我们确定了 7 项与急性缺血性脑卒中急救护理相关的质量指标，这些指标分为 4 个主要类别：脑部影像学、溶栓治疗、吞咽困难筛查和死亡率。在这 7 项措施中，有 3 项符合 ACC/AHA 的全部 4 项评估标准：24 小时内进行脑部影像学检查、症状发作后 3 小时内进行溶栓治疗以及入院后 60 分钟内进行溶栓治疗。不符合所有评估标准的措施包括：45 分钟内完成脑部影像学报告、考虑溶栓治疗、吞咽困难筛查和死亡率。在美国，用于反映急性缺血性脑卒中患者高质量急救护理的措施仍有改进的空间。
