Potentially avoidable complications following stroke

Measure purpose: Ensure patients are prescribed appropriate statin therapy.

The numerator:  Patients aged 18 years to 74 years with a diagnosis of acute ischemic stroke
or transient ischemic attack (TIA) who were prescribed high intensity statin therapy* and patients aged 75 and older who were prescribed moderate* or high intensity statin therapy at discharge

*See measure specifications for complete list of definitions and medication ranges.

is divided by

the denominator:  all patients aged 18 years and older with a diagnosis of acute ischemic stroke or TIA

Exclusions are removed from the denominator:

• Documentation of medical reason(s) for not prescribing high intensity statin therapy at discharge:
  • Contraindication to statin therapy including but not limited to: liver disease, patient taking medication with significant interaction to statin, statin allergy/intolerance
  • etiology of stroke presumed to be NON-atherosclerotic (e.g. cardioembolic, secondary to dissection/trauma, vasculitis, etc.) AND absence of clinical ASCVD*
• Documentation of patient reason(s) for not prescribing high intensity statin therapy at discharge:
  • Patient expired during hospitalization
  • Patient discharged to hospice or made comfort care
  • Patient left against medical advice
  • Patient refused treatment

Key Phrases

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

• Rx'd atorvastatin 40 mg everyday
• Rx'd fluvastatin 40 mg twice daily
• Rx'd simvastatin 20 mg everyday

Measure Calculation Example

Dr. Larsen oversaw discharge of 100 patients aged 18 and older between January 1 and December 31 with a diagnosis of acute ischemic stroke or TIA. This is the denominator.

Two patients had a contraindication to statin therapy, three patients had an etiology of stroke presumed to be non-atherosclerotic, and four patients were discharged to hospice services. These nine (2+3+4) patients are removed from the denominator as they meet exclusions.

Of the remaining 91 patients, Dr. Larsen documented prescriptions for high-intensity statin or moderate intensity statin for those 75 years and older for 61 patients.

Quality of patient care = 61/(100-9). Dr. Larsen has a score of 67% for this measure.