Across our four stroke centers at NewYork-Presbyterian Hospital (NYP), we are dedicated to achieving the highest outcomes and continuously work to improve the care and treatment of our stroke patients. We participate in Get With The Guidelines® - Stroke (GWTG), an in-hospital program designed to improve the treatment given to people who have had a stroke, and are measured against the standards established within the program in collaboration with the American Heart Association and the American Stroke Association. There are 2,556 hospitals participating in the Get With The Guidelines program today.
Our stroke centers continuously receive awards from the American Heart Association and American Stroke Association for superior stroke care.
Below are examples of the performance measures that we monitor and report in order to improve the care and the outcomes of our stroke patients.
1. Treating patients with ischemic stroke as quickly as possible is critical in order to achieve better neurologic outcomes. tPA (tissue plasminogen activator), the clot-busting drug used to treat ischemic stroke, can only be administered within 4.5 hours of stroke symptom onset in order to be effective, and the sooner it is administered, the better. In 2015 we administered tPA to patients with ischemic stroke within 60 minutes, from the time they arrived at our Hospital, 99.3% of the time. This compares with an average of 76.4% for Academic Medical Centers around the country, and an average of 79.9% for hospitals in New York City.
A higher percentage is better.
2. Beginning in 2013, the Centers for Medicare and Medicaid Services (CMS) began to collect data on stroke core measures, a set of care processes developed by the Joint Commission to improve the quality of health care by implementing a national standardized performance measurement system. Such core measures have been shown to reduce the risk of complications, prevent recurrences and improve the quality of patient care.
In 2015 our performance in stroke core measures versus other hospitals was as follows.
A higher percentage is better.
|Stroke Core Measures||NYP||Hospital Compare National Average|
|Ischemic stroke patients who got medicine to break up a clot within 3 hours after symptoms started||100%||81%|
|Ischemic stroke patients who received medicine known to prevent complications caused by blood clots within 2 days of arriving at the hospital||99.6%||98%|
|Ischemic or hemorrhagic stroke patients who received treatment to keep blood clots from forming anywhere in the body within 2 days of arriving at the hospital||99.5%||97%|
|Ischemic stroke patients who received a prescription for medicine known to prevent complications caused by blood clots before discharge||99.8%||99%|
|Ischemic stroke patients with a type of irregular heartbeat who were given a prescription for a blood thinner at discharge||100%||97%|
|Ischemic stroke patients needing medicine to lower cholesterol, who were given a prescription for this medicine before discharge||99.8%||97%|
|Ischemic or hemorrhagic stroke patients or caregivers who received written educational materials about stroke care and prevention during the hospital stay||99.6%||94%|
|Ischemic or hemorrhagic stroke patients who were evaluated for rehabilitation services||99.4%||98%|
For more information on core measures, please see medicare.gov
3. Diagnostic cerebral angiography is a minimally invasive procedure to evaluate the blood vessels in the head or neck in order to assess for blockages or narrowing of such blood vessels or other abnormalities. This procedure is used to help diagnose and determine the best treatment for certain stroke patients and is conducted by specifically trained specialists.
4. Stroke patients may show blockages or narrowing of the carotid arteries, which are the arteries in the neck that supply blood to the brain. Carotid endarterectomies (CEA) and carotid artery stenting (CAS) are procedures that are performed to remove the blockages in the carotid arteries and may be performed in order to reduce the risk of stroke or even prevent a second stroke.
The Joint Commission (JC) standard is to have an aggregate complication rate of < 6% following symptomatic CEA and CAS. The Joint Commission standard aggregate complication rate for asymptomatic CEA and CAS is < 3%. Our stroke centers performed better then these standards as shown below. Complications include stroke and death.
Symptomatic refers to patients who show symptoms of a disease or condition, whereas asymptomatic refers to patients who do not show symptoms of a disease or condition.
A lower percentage is better.