Clinical Performance Measures for Stroke Rehabilitation: Performance Measures From the American Heart Association/American Stroke Association

You will notice that NONE  of the thirteen talk about 100% recovery. And until stroke survivors change that, survivors will continued to be screwed in not recovering.

 Clinical Performance Measures for Stroke Rehabilitation: Performance Measures From the American Heart Association/American Stroke Association

Performance Measures From the American Heart Association/American Stroke Association Joel Stein, MD, FAHA, Chair; Douglas I. Katz, MD, Vice Chair; Randie M. Black Schaffer, MD, MA; Steven C. Cramer, MD; Anne F. Deutsch, RN, PhD; Richard L. Harvey, MD; Catherine E. Lang, PT, PhD; Kenneth J. Ottenbacher, PhD, OTR; Janet Prvu-Bettger, ScD; Elliot J. Roth, MD; David L. Tirschwell, MD, MSc; George F. Wittenberg, MD, PhD; Steven L. Wolf, PT, PhD; T. Prashant Nedungadi, PhD; on behalf of the American Heart Association/American Stroke Association ABSTRACT: The American Heart Association/American Stroke Association released the adult stroke rehabilitation and recovery guidelines in 2016. A working group of stroke rehabilitation experts reviewed these guidelines and identified a subset of recommendations that were deemed suitable for creating performance measures. These 13 performance measures are reported here and contain inclusion and exclusion criteria to allow calculation of rates of compliance in a variety of settings ranging from acute hospital care to postacute care and care in the home and outpatient setting. Key Words: AHA Scientific Statements ◼ process assessment, health care ◼ rehabilitation ◼ stroke KEY MESSAGES • Stroke rehabilitation begins during acute hospital care and continues throughout the life span for many individuals who have sustained a stroke. • Performance measures for stroke rehabilitation have been developed that are based on the 2016 American Heart Association (AHA)/American Stroke Association (ASA) adult stroke rehabilitation and recovery guidelines. • Improving adherence to these measures has the potential to improve rehabilitative care after stroke and to improve the lives of stroke survivors. INTRODUCTION Stroke is among the most common causes of acquired disability among adults in the United States, with >7 million Americans >20 years of age having experienced a stroke in the past and ≈2.5% of Americans reporting that they are disabled as a result of stroke.1 A large percentage of patients discharged from the hospital after stroke receive care and rehabilitation in an inpatient rehabilitation facility (IRF; 19%), skilled nursing facility (SNF; 25%), or home care services (12%).2 Stroke rehabilitation encompasses a broad range of activities, including skilled therapy interventions to address mobility and activities of daily living (ADL), evaluation and treatment of communication and cognitive impairments, and treatment of dysphagia. In addition, stroke rehabilitation incorporates prevention and treatment of medical and mental health complications such as aspiration pneumonia, soft-tissue contractures, decubitus ulcers, infection, deep vein thrombosis (DVT), malnourishment, and depression. There is no established time frame for rehabilitation after stroke, and some interventions are applicable as early as the emergency department, whereas others may start in postacute care and continue lifelong after stroke. There is substantial variation in rehabilitative care in the United States, and many people with stroke receive less than optimal stroke rehabilitation over the course of their illness and recovery, often attributable to variable availability of postacute stroke services, discontinuities in care, and lack of consistent follow-up. Whereas rehabilitation services are commonly provided to people with stroke, there is opportunity for improved standardization and quality monitoring of these services throughout all phases of care. The AHA/ASA published “Guidelines for Adult Stroke Rehabilitation and Recovery”3 in 2016 in an effort to update evidencebased guidance for the provision of stroke rehabilitation. Publication of guidelines is just the first step in ensuring quality of care. Dissemination, acceptance, implementation, and monitoring are necessary to ensure both adoption of the guidelines and enhancement of their impact on care delivery and patient outcomes. There is evidence of variability in stroke rehabilitation in the United States and in compliance with stroke rehabilitation guidelines, despite evidence of improved outcomes with adherence to guidelines.4–6 In an effort to assist in measuring adherence to the 2016 AHA/ASA stroke rehabilitation guidelines, the AHA/ASA Stroke Performance Measures Oversight Committee commissioned a group of stroke rehabilitation professionals to develop a set of performance measures for stroke rehabilitation that were reliable, measurable, and meaningful. This group drew on knowledge from professionals with a broad range of expertise in poststroke rehabilitation. The group reviewed the AHA stroke rehabilitation guidelines and collectively identified recommendations that are impactful on stroke rehabilitation care, actionable, and measurable. The purpose of these performance measures is to promote guideline-recommended care for people with stroke in the United States. Although the stroke rehabilitation guidelines and performance measures were developed for use in the United States, many are likely to be applicable in other countries and health care systems. Although these performance measures are reported as a set of 13 measures, they are suitable for use individually or as a subset by entities focusing on particular aspects of poststroke rehabilitation care. These performance measures focus on process of care rather than outcomes, consistent with the emphasis of process of care in the stroke rehabilitation guidelines that form the basis of these measures. We anticipate that performance measures incorporating outcomes of rehabilitative care will be developed.