Post-acute ischemic stroke screening and care measure bundle

Measure bundle purpose: Ensure patients receive optimal post-acute care.

The numerator has six components, all of which must be met:

1. Patients with a blood pressure <140/90 mmHg OR patients with a blood pressure ≥140/90 mmHG who were:
   1. prescribed 2 or more anti-hypertensive agents,
   2. referred back to Primary Care Provider (PCP) when BP noted to be >140/90 mmHg, OR
   3. medical rationale documented for more liberal blood pressure management
2. Patients screened for diabetes mellitus with either fasting plasma glucose, HbA1C or glucose tolerance test 
3. Patients diagnosed with ischemic stroke on appropriate antithrombotic* 
4. Patients with stroke who have documentation of active smoking status OR former smoker with quit date less than 1 year from time assessment provided counseling on the bad effects of tobacco, the benefit of quitting AND at least one of the following:
   1. Referral back to PCP for tobacco cessation support, AND/OR
   2. Referral to tobacco cessation clinic or tobacco dependence telephone quitline, AND/OR
   3. Prescription of tobacco dependence medications including nicotine replacement therapies products, bupropion SR or varenicline, or any FDA-approved drugs for tobacco dependence therapies or referral to PCP
5. Patients prescribed or counseled on participating in an exercise program
6. Patient is screened for depression using a validated instrument at least once upon arrival at outpatient care

is divided by

the denominator:  all patients aged 18 years and older with a diagnosis of ischemic stroke or transient ischemic attack (TIA) evaluated within three months on an ambulatory visit.

Exclusions are removed from the denominator:

For all components:

• Patient declines treatment and screening
• Patient enrolled in a clinical trial
• Contraindication documented

For component 5 only:

• Patients with documented contraindication or physical inability to participate in an exercise program

For component 6 only:

• Patients with aphasia or other medical condition that precludes use of any validated screening tool

Key Phrases

Examples of key phrases you could use to meet the measure include:

• Blood pressure within normal limits (document score)
• Patient screened for diabetes
• Patient prescribed antithrombotic (list prescription name)
• Patient active smoker counseled on effects and benefits to quitting; referred to PCP for further treatment
• Counseled on exercise
• Patient screened for depression (list tool and numerical score)
• PHQ-9 (followed by numerical score)

Measure Calculation Example

This measure utilizes an all-or-none calculation strategy. For a more comprehensive explanation of how measure bundles are calculated please view this 17-minute webinar (download).

Dr. Martin sees 5 patients (A, B, C, D, and E) between January 1 and December 31 that were diagnosed with ischemic stroke or TIA within three months on an ambulatory visit.

1. All five patients A, B, C, D, and E had a blood pressure score documented <140/90 mmHg.
2. Four patients A, B, D, and E had diabetes screening documented. C did not.
3. Four patients A, B, C, and E had an appropriate antithrombotic.D was diagnosed with TIA and is not included for this component.
4. Four patients A, B, C, and D had documentation that they were former smokers. E did not, and there was no documentation counseling was provided.
5. All five patients A, B, C, D, and E were counseled on exercise programs.
6. Four patients A, B, D, and E had depression screenings documented. C did not.

Dr. Martin's performance rate is 60% for this measure. 3 patients (A, B, D) met the bundle/5 patients (D removed from component 3) in the denominator.