Carotid imaging measure

Measure purpose: Ensure patients receive timely vascular imaging and carotid revascularization referral if appropriate.

The numerator: patients for whom cross sectional imaging of the cervical cerebral vasculature, which at a minimum includes imaging* of the carotid artery, was performed for patients within 24 hours of inpatient admission or for patients attending an outpatient visit within 2 days.

For those patients identified as having symptomatic stenosis between >/=70% and <100% based on the NASCET method, order for referral to carotid revascularization practice within 24 hours of imaging result availability. If stenosis is less than 70%, documentation of degree of stenosis fulfills this measure.

is divided by

the denominator: all patients aged 18 years and older with symptoms or a diagnosis of TIA or non-disabling ischemic stroke*

Exclusions are removed from the denominator:

• Documentation of posterior fossa localization
• Patient not a surgical or interventional candidate
• Patient has unstable medical condition or contraindication that prevents imaging (e.g., renal failure)
• Patient declined/Left AMA

*See full measure specifications for complete definitions.

Key Phrases

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

• Imaging of carotid artery performed within 24 hours of admission
• Referred to revascularization specialist 
• Stenosis less than 70% no referral made as a result

To meet the measure both components imaging and referral must be documented.

Measure Calculation Example

Dr. Sood treated 50 patients between January 1 and December 31 aged 18 years and older with symptoms or a diagnosis of TIA or non-disabling ischemic stroke during their inpatient admission. This is the denominator.

Three patients had documentation of posterior fossa localization, two patients were not interventional candidates, one patient had renal failure preventing imaging, and three patients declined imaging or a referral to revascularization specialist. These nine (3+2+1+3) patients are removed from the denominator as they meet exclusions.

Of the remaining 91 patients, Dr. Sood documented imaging of the carotid artery within 24 hours of their admission for 61 patients. Of these 61 patients, 33 had documentation of a referral to a revascularization specialist. This is the numerator.

Quality of patient care = 33/(100-9). Dr. Sood has a score of 36.3% for this measure.