By using the NIHSS they still are not objectively reporting on stroke severity. You need 3d scans to do that. My god, the massive amount of incompetence out there in stroke land.
Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization
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Abstract
Background and Purpose—The
Centers for Medicare & Medicaid Services publicly reports a
hospital-level stroke mortality measure that lacks stroke severity risk
adjustment. Our objective was to describe novel measures of stroke
mortality suitable for public reporting that incorporate stroke severity
into risk adjustment.
Methods—We
linked data from the American Heart Association/American Stroke
Association Get With The Guidelines-Stroke registry with Medicare
fee-for-service claims data to develop the measures. We used logistic
regression for variable selection in risk model development. We
developed 3 risk-standardized mortality models for patients with acute
ischemic stroke, all of which include the National Institutes of Health
Stroke Scale score: one that includes other risk variables derived only
from claims data (claims model); one that includes other risk variables
derived from claims and clinical variables that could be obtained from
electronic health record data (hybrid model); and one that includes
other risk variables that could be derived only from electronic health
record data (electronic health record model).
Results—The
cohort used to develop and validate the risk models consisted of
188 975 hospital admissions at 1511 hospitals. The claims, hybrid, and
electronic health record risk models included 20, 21, and 9
risk-adjustment variables, respectively; the C statistics were 0.81,
0.82, and 0.79, respectively (as compared with the current publicly
reported model C statistic of 0.75); the risk-standardized mortality
rates ranged from 10.7% to 19.0%, 10.7% to 19.1%, and 10.8% to 20.3%,
respectively; the median risk-standardized mortality rate was 14.5% for
all measures; and the odds of mortality for a high-mortality hospital
(+1 SD) were 1.51, 1.52, and 1.52 times those for a low-mortality
hospital (−1 SD), respectively.
Conclusions—We
developed 3 quality measures that demonstrate better discrimination
than the Centers for Medicare & Medicaid Services’ existing stroke
mortality measure, adjust for stroke severity, and could be implemented
in a variety of settings.
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