Stroke Quality Measures

Get With the Guidelines — Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll Elite Plus

Hospitals receiving Get with the Guidelines^® Gold Plus Achievement Award have reached an aggressive goal of treating patients with 85 percent or higher compliance to core standard levels of care as outlined by the American Heart Association/American Stroke Association^® for two consecutive calendar years. In addition, those hospitals have demonstrated 75 percent compliance to seven out of ten stroke quality measures during the 12-month period. This is the fourth year in a row that CentraCare Neurosciences Stroke Center at the St. Cloud Hospital has achieved this award. 

To qualify for the Target:Stroke Honor Role Elite Plus, hospitals must achieve Time to Intravenous Thrombolytic Therapy ≤ 60 minutes in 75 percent or more of applicable acute ischemic stroke patients treated with IV alteplase. Hospitals must also achieve Time to Intravenous Thrombolytic Therapy within 45 minutes in 50 percent or more of applicable acute ischemic stroke patients treated with IV alteplase. 

About Get With the Guidelines^®

Get With the Guidelines^® is the American Heart Association/American Stroke Association's hospital-based quality improvement program that provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With the Guidelines has touched the lives of more than five million patients since 2001. 

St. Cloud Hospital's 2017 in-hospital mortality report (see below) were obtained through Get With the Guidelines-Stroke. Acute ischemic stroke calculations include adjustments using the National Institutes of Health Stroke Scale (NIHSS). Risk-adjusted mortality takes into account co-morbidities that would increase mortality and is considered the expected mortality. When compared to national benchmarks, the observed mortality is higher for acute ischemic and intracerebral hemorrhagic strokes, however; the risk adjusted mortality is significantly higher indicating that the St. Cloud Hospital cares for sicker patients with higher expected mortality rates.

All-Cause 30-Day Readmissions
Centers for Medicare and Medicaid Service (CMS) reporting period from third quarter 2013 through second quarter 2016 listed St. Cloud Hospital's All-Cause 30-Day readmission rate at 12.2 percent, which is reported as "no different than" the national rate. 

The graph below compares the IV alteplase and mechanical thrombectomy 2017 usage rate for Stroke Center patients to national benchmarks. We have a developed telestroke system where stroke providers consult with emergency department providers on IV alteplase administration. Our admission rates at outside facilities are higher than national benchmarks. 

The graph below demonstrates St. Cloud Hospital has a lower door-to-needle median time compared to national benchmarks. 

It is recommended that patients that are eligible for a thrombectomy receive treatment as quickly as possible. That national proposed benchmark is based on recent clinical trials and includes both patients that were transferred from outside hospitals and those that came directly to the stroke center emergency room. The transfer time from outside hospitals can vary greatly due to distance from the stroke center. The graph below shows the breakdown between these two categories for St. Cloud Hospital and that performance is better than the proposed national benchmark in both categories. 

The graph below shows St. Cloud Hospital has comparable 2017 thrombolytic complication rates compared to national benchmarks. Thrombolytic therapy refers to IV alteplase or mechanical thrombectomy. Thrombolytic complications are defined as life-threatening serious system hemorrhages or symptomatic brain hemorrhages within 36 hours of IV alteplase or other serious complications that require additional medical interventions or a prolonged hospital stay. 

The National Institutes of Health Stroke Scale (NIHSS) is validated clinical assessment that provides quantitative measure of stroke severity. The scale ranges from 0, being no deficits to 42, being a severe stroke. The graphs below illustrate greater improvements in 2017 stroke severity upon discharge for patients that receive IV alteplase and/or mechanical thrombectomy.