Stroke Rehabilitation Performance Measures: A Road Map to Quality Improvement

I can't find this, so I have to assume it has nothing useful in it. Especially since they talk about 'care' NOT RESULTS.

Stroke Rehabilitation Performance Measures: A Road Map to Quality Improvement

Terrie Black DNP, MBA, CRRN, FAHA, FAAN Clinical Associate Professor Chair, CVSN Council Corresponding author: Terrie Black Address: University of Massachusetts – Amherst College of Nursing 104 Skinner Hall 651 North Pleasant Street, Amherst, MA 01003 Email: tblack@umass.edu ORCID 0000-0001-6144-2134 Phone: 716-863-3099 Figures: 0; Tables: 0 Keywords: stroke, stroke rehabilitation, quality improvement Total Word Count: 1127 This article is published in its accepted form, it has not been copyedited and has not appeared in an issue of the journal. Preparation for inclusion in an issue of Stroke involves copyediting, typesetting, proofreading, and author review, which may lead to differences between this accepted version of the manuscript and the final, published version. Downloaded from http://ahajournals.org by on November 23, 2021 Editorial: 10.1161/STROKEAHA.121.037020 2 Stroke Rehabilitation Performance Measures: A Road Map to Quality Improvement The article Clinical performance measures for stroke rehabilitation: Performance measures from the American Heart Association/American Stroke Association1 could not have come at a better time. Today’s providers and payers are focused on value added benefits within an era demanding (and expecting) high quality healthcare services. Stroke is a global burden and affects not just individual, but families, caregivers and society. Having the AHA Guidelines for Adult Stroke Rehabilitation and Recovery2 is a fundamental, evidence-based resource for clinicians to provide organized, consistent, coordinated, and equitable care(NOT RESULTS!) for persons with stroke. However, another critical component for stroke programs and team members is to measure and monitor performance of programmatic stroke care(NOT RESULTS!). Utilizing the 13 standardized performance measures described by Stein et al.1 , stroke rehabilitation programs can identify areas of program strengths as well as opportunities for improvement. The 13 performance measures focus primarily on the process of clinical care(NOT RESULTS!), supporting an organized approach for quality improvement to be incorporated into clinical practice for care(NOT RESULTS!) of persons with stroke. The practice guidelines suggest that stroke survivors who qualify and have access to an intensive rehabilitation facility setting should receive services in that venue; however, the performance measures can be adopted in other settings within the care(NOT RESULTS!) continuum such as acute care(NOT RESULTS!), post-acute care(NOT RESULTS!), home health or outpatient settings. The performance measures are intended for the adult patient with stroke versus the pediatric population; and it is important to keep in mind that individualized patient care(NOT RESULTS!), treatment and interventions are still required. The Donabedian3 model is a framework utilized in healthcare to evaluate quality services. Using the Donabedian model as the basis for performance improvement, measures within healthcare used to assess quality include structures (the setting, equipment and personnel of an organization), processes (the actions or how care(NOT RESULTS!) is delivered) and outcomes (results). This is essential for process improvement. It is equally important to not just merely collect data, but to analyze and act upon data as well. Maintaining data quality and integrity is necessary for a systematic, methodical approach for quality improvement. Thus, by utilizing these performance measures, stroke rehabilitation programs within the United States and throughout the world can begin to ask: Where are the gaps in care(NOT RESULTS!)? What is working within our program? What program data are being collected and why? How often are data collected? How are data shared and disseminated to various stakeholders? What tools are needed for process and quality improvement within the stroke rehabilitation program? Measuring data to evaluate structures, processes and outcomes can lead to more immediate improvements in clinical care(NOT RESULTS!) (short term) as well as sustained improvements (long term). Utilizing a rapid cycle process improvement approach, in concordance with the defined stroke rehabilitation performance measures, clinicians can improve processes which positively Downloaded from http://ahajournals.org by on November 23, 2021 Editorial: 10.1161/STROKEAHA.121.037020 3 impact clinical care(NOT RESULTS!) and outcomes. Once positive change has been observed in the short term, it is critical to hardwire changes such that the positive change is sustained and maintained for the long term. Globally, process improvement can occur within various healthcare organizations as each entity can evaluate processes and structures unique or novel to the respective institution. Inclusion of stroke rehabilitation team members needs to be a key consideration when selecting the performance measures. Programs leaders may select either one or two particular metrics, or they may choose a composite group of metrics. However, having interprofessional and interdisciplinary team buy in of performance measures is a necessary component to ensure program success. Each measure specifies inclusion and exclusion criteria along with potential barriers for implementation. Having this valuable insight can provide program leaders a proactive approach to measure selection, implementation and evaluation. The key to success will be not focusing on a single metric, but rather a composite of metrics which are both relevant to the program and in which an opportunity or need for improvement has been identified. In other words, program leaders must seek a balance of performances measures in which to monitor. This, along with having an organizational leadership commitment to quality and process improvement, will result in the greatest likelihood for programmatic success. Data should drive program priorities. Although data collection by stroke rehabilitation programs is one aspect of quality improvement, dissemination of program performance is needed. Communication of data and program performance should be a standard of practice for all stroke rehabilitation programs; however, without incentives or mandates by payors or accreditation agencies, this sharing of information may not be viewed as necessary by the program. Without standards or minimum requirements in which to share programmatic outcomes, data may be portrayed inconsistently or lack transparency for patients and consumers of services. It is prudent for entities such as accreditation agencies, patients and other stakeholders to assess and evaluate stroke rehabilitation programs performance on these measures to ensure transparency, and guide decision making and selection of a high-quality, high performing stroke rehabilitation program. While the performance measures are not all inclusive, they can readily serve as framework in which stroke rehabilitation programs can utilize to direct quality improvement initiatives across the care(NOT RESULTS!) continuum. Disclosures: TB is a Nurse Reviewer, DSC Certification, for the Joint Commission.