• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.



• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.2]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Feb 29. 37 p.

Does not apply to this measure

This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of stroke.

Some stroke care occurs in an outpatient setting, and selection bias may be a problem for this indicator. In addition, 30-day mortality may be somewhat different than in-hospital mortality, leading to information bias. Risk adjustment for clinical factors (or at a minimum 3M™ All-Patient Refined Diagnosis-Related Groups [APR-DRGs]) is recommended. Coding appears suboptimal for acute stroke and may lead to bias.

About 30% of personal health care expenditures in the United States go towards hospital care, and the rate of growth in spending for hospital services has only recently leveled out after several years of increases following a half a decade of declining growth. Simultaneously, concerns about the quality of health care services have reached a crescendo with the Institute of Medicine's series of reports describing the problem of medical errors and the need for a complete restructuring of the health care system to improve the quality of care. Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track, and improve the quality of inpatient care.

Quality treatment for acute stroke must be timely and efficient to prevent potentially fatal brain tissue death, and patients may not present until after the fragile window of time has passed. Better processes of care may reduce short-term mortality, which represents better quality.

Note:

The following caveats were identified from the literature review for the "Acute Stroke Mortality Rate" indicator:

• Selection bias^b: This results when a substantial percentage of care for a condition is provided in the outpatient setting, so the subset of inpatient cases may be unrepresentative. Examination of outpatient care or emergency care data may help to reduce this in these cases.
• Information bias^a: This indicator is based on information available in hospital discharge data sets, but some missing information may actually be important to evaluating the outcomes of hospital care. Examination of missing information may help to improve indicator performance in these cases.
• Confounding bias^b: Patient characteristics may substantially affect the performance of the indicator; risk adjustment is recommended.

Refer to the original measure documentation for further details.

a - The concern is theoretical or suggested, but no specific evidence was found in the literature.

b - Indicates that the concern has been demonstrated in the literature.

Acute stroke; mortality

All discharges, age 18 years and older, with a principal diagnosis code for stroke

Exclude cases:

• Missing discharge disposition
• Transferring to another short-term hospital
• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
• MDC 15 (newborns and other neonates)

Note: Refer to the Technical Specifications document for specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Number of deaths among cases meeting the inclusion and exclusion rules for the denominator

Administrative data

Acute stroke mortality rate (IQI 17).

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality (AHRQ)

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators are in the public domain and the specifications come from multiple sources, including the published and unpublished literature, users, researchers, and other organizations. AHRQ as an agency is responsible for the content of the indicators.

None

National Quality Forum

Measure was not adapted from another source.

2002 Jun

2008 Feb

This is the current release of the measure.

This measure updates previous versions:

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals -- volume, mortality, and utilization [version 3.0]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Feb 20. 99 p.
• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 37 p.

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.



• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.2]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Feb 29. 37 p.

This NQMC summary was completed by ECRI on December 4, 2002. The information was verified by the Agency for Healthcare Research and Quality on December 26, 2002. This NQMC summary was updated by ECRI on April 7, 2004, August 19, 2004, and March 4, 2005. The information was verified by the measure developer on April 22, 2005. This NQMC summary was updated again by ECRI Institute on August 17, 2006, on May 29, 2007, and again on October 20, 2008.

No copyright permissions apply.