Clinical Performance Measures for Emergency Department Care for Adults With Intracranial Hemorrhage - 16/08/23
, Joshua N. Goldstein, MD, PhD a, Edward Jauch, MD, MS b, Ryan P. Radecki, MD c, Tracy E. Madsen, MD, PhD d, Opeolu Adeoye, MD, MS e, John A. Oostema, MD, MS f, V. Ramana Feeser, MD g, Latha Ganti, MD, MS h, Bruce M. Lo, MD, MBA i, William Meurer, MD, MS j, Mitra Corral, MS, MPH k, Craig Rothenberg, MPH l, Anshita Chaturvedi, MD, MPH m, Pawan Goyal, MD m, Arjun K. Venkatesh, MD, MBA lAbstract |
Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage, emergency departments lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative. To develop the measure set, we convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure: internal quality improvement, benchmarking, or accountability, and examined data from Emergency Quality Network Stroke Initiative-participating EDs to consider the validity and feasibility of proposed measures for quality measurement and improvement applications. The initially conceived set included 14 measure concepts, of which 7 were selected for inclusion in the measure set after a review of data and further deliberation. Proposed measures include 2 for quality improvement, benchmarking, and accountability (Last 2 Recorded Systolic Blood Pressure Measurements Under 150 and Platelet Avoidance), 3 for quality improvement and benchmarking (Proportion of Patients on Oral Anticoagulants Receiving Hemostatic Medications, Median ED Length of Stay for admitted patients, and Median Length of Stay for transferred patients), and 2 for quality improvement only (Severity Assessment in the ED and Computed Tomography Angiography Performance). The proposed measure set warrants further development and validation to support broader implementation and advance national health care quality goals. Ultimately, applying these measures may help identify opportunities for improvement and focus quality improvement resources on evidence-based targets.
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| Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The American College of Emergency Physicians (ACEP) Emergency Quality Network collaborative is supported by Genentech. KSZ reports funding from ACEP related to the submitted work and funding from NIH/NINDS, CRICO Risk Management Foundation, the American Heart Association, and the Massachusetts General Hospital Executive Committee on Research unrelated to the submitted work. JNG reports support from NIH, Pfizer, Octapharma, Takeda, CSL Behring, Alexion, NControl, and Cayuga, unrelated to the submitted work. EJ reports receiving research funding from RAPID.AI and Genetech and consulting fees, including medical-legal consulting unrelated to the submitted work. TEM reports funding from NIH/NINDS unrelated to the submitted work. OA reports research funding from NIH/NINDS and equity holder and founder of Sense Diagnostics, Inc. JAO reports receiving funding from the Michigan Department of Health and Human Services, Michigan State University, and Spectrum Health unrelated to the submitted work. VRF reports being a subinvestigator on the NIH StrokeNet FASTEST trial, unrelated to the submitted work. WM reports unrelated income from ACEP (as methodology statistics reviewer for Annals of Emergency Medicine), Berry Consultants, and from medicolegal case review (no cases directly related to content). He also reports unrelated grant funding from AHRQ and NIH. MC reports being an employee and stockholder of Genentech, Inc. AKV reports support from the Centers for Medicare and Medicaid Services for the development of hospital and health system quality measures and rating systems, support from the Gordon and Betty Moore Foundation for the development of quality measures and stroke quality improvement initiatives, leadership roles in ACEP for the development, maintenance, and implementation of quality measures, and consulting roles with Liminal Sciences as well as AHRQ, UCSF, Johns Hopkins, Moore Foundation, and American College of Radiology quality measure development efforts. |
Vol 82 - N° 3
P. 258-269 - septembre 2023 Retour au numéro
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