Examine your stroke treatment beneath the surface 21

The STK-4 metric only represents the tip of the iceberg while the All-AIS treatment rate provides a broader perspective
Centers for Medicare and Medicaid Services (CMS) requires reporting on designated quality measures, such as STK-4, in order to receive a higher annual update to Medicare MS-DRG rates. However, the STK-4 treatment rate does not account for certain patients with AIS in your hospital including:
  • Those who have any documented reason for not initiating Activase®
  • Those who do not arrive within 2 hours of the time last seen normal
  • Other reasons such as age, length of stay <120 days, clinical trial enrollment, and admission for elective carotid intervention
In contrast, an All-AIS treatment rate is a more comprehensive metric that provides a broader perspective by measuring the percentage of patients with a discharge diagnosis of AIS that were treated with Activase®. An All-AIS treatment rate can potentially identify missed eligible patients. With an All-AIS treatment rate:
  • Every patient is tracked, which can provide better information about the AIS patient population
  • No patients are excluded
  • Eligible and ineligible patients are accounted for

For eligible patients, it is important to consider the entire safety profile when making treatment decisions. According to the labeled indication, treatment must be initiated within 3 hours of symptom onset, after the exclusion of ICH as the primary cause of stroke signs and symptoms.

STK-4 treatment

Hypothetical example. Not based on actual patient data.

AN ALL-AIS TREATMENT RATE CAPTURES EVERY PATIENT WITH AIS
Considering the All-AIS treatment rate, would it be valuable to have a deeper understanding of the reasons why patients diagnosed with AIS were not considered for Activase?
  • How many were outside the Activase time window?
  • How many were excluded due to contraindications?
  • How many were perceived ineligible?
  • What is the STK-4 treatment rate at your institution? What is the overall AIS treatment rate?
  • Considering this larger pool of patients, what conclusions can be drawn about your institution’s stroke program?

DO YOU TRACK EVERY DISCHARGED PATIENT WITH A CONFIRMED AIS DIAGNOSIS, ALL-AIS TREATMENT RATES, REGARDLESS OF TREATMENT OPTIONS?

NEXT: Identify process gaps to improve your stroke program >

DID YOU KNOW?

  • The stroke (STK)-4 treatment rate excludes patients with any documented reason for not initiating an IV thrombolytic therapy and may not account for all patients for whom treatment may be appropriate.
  • Consider an all-encompassing treatment rate that can be calculated by accounting for every discharged patient with a confirmed AIS diagnosis.