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## Complete Summary

#### TITLE

Stroke and stroke rehabilitation: percentage of patients aged 18 years
and older with a diagnosis of ischemic stroke or TIA or intracranial
hemorrhage undergoing CT or MRI of the brain within 24 hours of arrival
at the hospital whose final report of the CT or MRI includes
documentation of the presence or absence of each of the following:
hemorrhage and mass lesion and acute infarction.

#### SOURCE(S)

American Academy of Neurology, American College of Radiology, Physician
Consortium for Performance Improvement®, National Committee for Quality
Assurance. Stroke and stroke rehabilitation physician performance
measurement set. Chicago (IL): American Medical Association, National
Committee for Quality Assurance; 2006 Sep. 19 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients aged 18 years
and older with the diagnosis of ischemic stroke or transient ischemic
attack (TIA) or intracranial hemorrhage undergoing computed tomography
(CT) or magnetic resonance imaging (MRI) of the brain within 24 hours of
arrival at the hospital whose final report of the CT or MRI includes
documentation of the presence or absence of each of the following:
hemorrhage **and** mass lesion **and** acute infarction.

#### RATIONALE

The computed tomography (CT) and magnetic resonance imaging (MRI)
findings are critical to initiating care for the patient with stroke.
All CT and MRI reports should address the presence or absence of these
three important findings. This documentation is particularly vital in
the report of the first imaging study performed after arrival at the
hospital, on which initial treatment decisions will be based.\*

\*The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represent the evidence base for the measure:

Brain imaging is required to guide acute intervention. (Grade A) There
is a uniform agreement that CT accurately identifies most cases of
intracranial hemorrhage and helps discriminate nonvascular causes of
neurological symptoms (e.g., brain tumor). With the advent of rtPA
treatment, interest has grown in using CT to identify subtle, early
signs of ischemic brain injury (early infarct signs) or arterial
occlusion that might affect decisions about treatment. The presence of
these signs is associated with poor outcomes. (American Stroke
Association \[ASA\])

A technically adequate head CT scan is required prior to administration
of thrombolytic therapy to exclude brain hemorrhage and nonischemic
diagnoses. The baseline CT scan is also sensitive for detection of early
signs of cerebral infarction. Subtle or limited signs of early
infarction on the CT scan are common even within the first 3 h of stroke
evolution. Preliminary data suggest that specific MRI profiles may
identify patients who are particularly likely to benefit from
thrombolytic therapy. New MRI techniques including perfusion-weighted
and diffusion-weighted may detect ischemic injury in the first hour and
may reveal the extent of reversible and irreversible injury. In
addition, MRI appears to be highly sensitive for identification of acute
brain hemorrhage. (American College of Chest Physicians \[ACCP\])

#### PRIMARY CLINICAL COMPONENT

Ischemic stroke; transient ischemic attack (TIA); intracranial
hemorrhage; computed tomography (CT) or magnetic resonance imaging (MRI)
of the brain; hemorrhage; mass lesion; acute infarction

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with the admitting diagnosis of
ischemic stroke or transient ischemic attack (TIA) or intracranial
hemorrhage undergoing computed tomography (CT) or magnetic resonance
imaging (MRI) of the brain within 24 hours of arrival at the hospital

#### NUMERATOR DESCRIPTION

Patients whose final report of the initial computed tomography (CT) or
magnetic resonance imaging (MRI) includes documentation of the presence
or absence of each of the following: hemorrhage **and** mass lesion
**and** acute infarction

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Antithrombotic and thrombolytic therapy for ischemic stroke: the
    Seventh ACCP Conference on Antithrombotic and Thrombolytic
    Therapy.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5896)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr
EA. The quality of health care delivered to adults in the United States.
N Engl J Med2003 Jun 26;348(26):2635-45.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12826639)

Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, Zheng ZJ,
Flegal K, O\'Donnell C, Kittner S, Lloyd-Jones D, Goff DC Jr, Hong Y,
Adams R, Friday G, Furie K, Gorelick P, Kissela B, Marler J, Meigs J,
Roger V, Sidney S, Sorlie P, Steinberger J, Wasserthiel-Smoller S,
Wilson M, Wolf P. Heart disease and stroke statistics\--2006 update: a
report from the American Heart Association Statistics Committee and
Stroke Statistics Subcommittee. Circulation2006 Feb 14;113(6):e85-151.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16407573)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients aged 18 years and older with the admitting diagnosis of
ischemic stroke or transient ischemic attack (TIA) or intracranial
hemorrhage undergoing computed tomography (CT) or magnetic resonance
imaging (MRI) of the brain within 24 hours of arrival at the hospital

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with the admitting diagnosis of
ischemic stroke or transient ischemic attack (TIA) or intracranial
hemorrhage undergoing computed tomography (CT) or magnetic resonance
imaging (MRI) of the brain within 24 hours of arrival at the hospital

**Exclusions**\
None

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Diagnostic Evaluation\
Institutionalization

#### DENOMINATOR TIME WINDOW

Time window is a fixed period of time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients whose final report of the initial computed tomography (CT) or
magnetic resonance imaging (MRI) includes documentation of the presence
or absence of each of the following: hemorrhage **and** mass lesion
**and** acute infarction

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Institutionalization

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #8: computed tomography (CT) or magnetic resonance imaging (MRI)
reports.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1907&doc=178)

#### MEASURE SET NAME

[Stroke and Stroke Rehabilitation Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1907&doc=10247)

#### SUBMITTER

American Medical Association on behalf of the American Academy of
Neurology, American College of Radiology, the National Committee for
Quality Assurance, and the Physician Consortium for Performance
Improvement®

#### DEVELOPER

American Academy of Neurology\
American College of Radiology\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Joseph Drozda, Jr., MD (*Co-Chair*); Robert Holloway, MD, MPH
(*Co-Chair*); David Seidenwurm, MD (*Co-Chair*); Chris Alexander, III,
MD, FACP; John Barr, MD; Oscar Benavente, MD, FRCPC; Christopher Bever,
Jr., MD, MBA; Thomas Bleck, MD FCCM; Ronald Gabel, MD; Judith Hinchey,
MD; Irene Katzan, MD; Rahul K. Khare, MD; Michael Lev, MD; John McMahon,
MD; Mark Morasch, MD, FACS; Suresh Mukherji, MD; Konrad C. Nau, MD; Sam
J. W. Romeo, MD, MBA; Eric Russell, MD, FACR; Marilyn Rymer, MD; Ajay
Sharma, MD; John Schneider, MD, PhD; Timothy Shephard, PhD; Michael A.
Sloan, MD, MS; William D. Smucker, MD, CMD; Patrick Turski, MD, FACR;
Linda Williams, MD; Richard Zorowitz, MD

Sarah Tonn, MPH, American Academy of Neurology

Sandra H. Bjork, RN, JD, American College of Radiology

Penelope Solis, JD, American Heart Association/American Stroke
Association

Andrea Gelzer, MD, MS, FACP, Health Plan Representative

Mark Antman, DDS, MBA, American Medical Association; Karen S. Kmetik,
PhD, American Medical Association; Beth Tapper, MA, American Medical
Association; Samantha Tierney, MPH, American Medical Association

Rebecca A. Kresowik, Facilitator; Timothy F. Kresowik, MD, Facilitator

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Sep

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Academy of Neurology, American College of Radiology, Physician
Consortium for Performance Improvement®, National Committee for Quality
Assurance. Stroke and stroke rehabilitation physician performance
measurement set. Chicago (IL): American Medical Association, National
Committee for Quality Assurance; 2006 Sep. 19 p.

#### MEASURE AVAILABILITY

The individual measure, \"Measure #8: Computed Tomography (CT) or
Magnetic Resonance Imaging (MRI) Reports,\" is published in the \"Stroke
and Stroke Rehabilitation: Physician Performance Measurement Set.\" This
document and technical specifications are available in Portable Document
Format (PDF) from the American Medical Association (AMA)-convened
Physician Consortium for Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on September 13, 2007.
The information was verified by the measure developer on October 26,
2007.

#### COPYRIGHT STATEMENT

© Measures including specifications

© 2005-6 American Medical Association and National Committee for Quality
Assurance

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008