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## Complete Summary

#### TITLE

Stroke and stroke rehabilitation: percentage of patients aged 18 years
and older with the diagnosis of ischemic stroke or intracranial
hemorrhage who underwent a dysphagia screening process before taking any
foods, fluids or medication by mouth.

#### 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 intracranial
hemorrhage who underwent a dysphagia screening process before taking any
foods, fluids, or medication by mouth.

#### RATIONALE

All patients should have their swallowing evaluated prior to receiving
food, fluids or oral medications to help prevent aspiration. The
evaluation should be performed with a validated or hospital-approved
dysphagia screening tool; a routine cranial nerve examination is not
sufficient.\*

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

Recommend that all patients have their swallow screened before
initiating oral intake of fluids or food, utilizing a simple valid
bedside testing protocol. (Veterans Administration/Department of Defense
\[VA/DoD\])

#### PRIMARY CLINICAL COMPONENT

Ischemic stroke; intracranial hemorrhage; dysphagia screening

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with the diagnosis of ischemic
stroke or intracranial hemorrhage who receive any foods, fluids or
medication by mouth (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who underwent a dysphagia screening process before taking any
foods, fluids or medication by mouth

### 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

-   [VA/DoD clinical practice guideline for the management of stroke
    rehabilitation in the primary care
    setting.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3846)

### 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)

Reeves MJ, Arora S, Broderick JP, Frankel M, Heinrich JP, Hickenbottom
S, Karp H, LaBresh KA, Malarcher A, Mensah G, Moomaw CJ, Schwamm L,
Weiss P, Paul Coverdell Prototype Registries Writing Group. Acute stroke
care in the US: results from 4 pilot prototypes of the Paul Coverdell
National Acute Stroke Registry. Stroke2005 Jun;36(6):1232-40.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15890989)

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

Advanced Practice Nurses\
Physician Assistants\
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 diagnosis of ischemic
stroke or intracranial hemorrhage who receive any foods, fluids or
medication by mouth

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with the diagnosis of ischemic
stroke or intracranial hemorrhage who receive any foods, fluids or
medication by mouth

**Exclusions**\
Documentation of medical reason(s) for not screening for dysphagia
before taking any foods, fluids or medication by mouth

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Institutionalization

#### DENOMINATOR TIME WINDOW

Time window brackets index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who underwent a dysphagia screening process before taking any
foods, fluids or medication by mouth

**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 #5: screening for dysphagia.

#### 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

This measure was harmonized to the extent possible with hospital level
measures for stroke developed by The Joint Commission.

#### PARENT MEASURE

Unspecified

#### 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 #5: Screening for Dysphagia,\" 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: 11/10/2008