Stroke Care
The Joint Commission in collaboration with the American Heart Association (AHA) / American Stroke Association (ASA) set out to develop performance measures for DSC Certification for Primary Stroke Centers, the first advanced-level certification program designed to recognize primary stroke centers that make exceptional efforts to foster better outcomes for stroke patient care. 
California Pacific received the American Stroke Association's Get With The Guidelines® - Stroke Gold Performance Achievement Award by reaching the goal of treating stroke patients with 85% or higher compliance to core standard levels of care.
tPA Rate
Stroke: Percentage of Ischemic Stroke Patients Treated with tPA (2007-Q2 2010)
Note: A higher percentage is better.
More than 90% of eligible patients at California Pacific Medical Center are treated. Source: California Pacific Medical Center Concurrent Review Data
| Year | 2007 | 2008 | 2009 | 2010 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Quarter | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 |
| tPA Rate | 21% | 26% | 28% | 26% | 23% | 23% | 24% | 29% | 21% | 23% | 27% | 29% | 21% | 22% |
What are we measuring? The percentage of patients with ischemic strokes (when blood supply to the brain is blocked) arriving at the emergency room who are able to receive tPA (clot dissolving medication) to potentially reverse the effects of an acute stroke.
Why is this important? tPA is a "clot-busting" medication that can potentially reverse the symptoms and effects of ischemic strokes. It must be given within the first 4.5 hours of the start of symptoms. Because of this narrow window of time and the inavailability of acute stroke management services, the nationwide average for this treatment is less than 5%.
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Performance Measures
California Pacific’s Comprehensive Stroke Care Center is a certified Primary Stroke Center receiving certification from The Joint Commission. The Joint Commission's stroke (STK) measures were developed in collaboration with the American Heart Association (AHA)/American Stroke Association (ASA)/Brain Attack Coalition (BAC) for use by Disease-Specific Care (DSC)-certified primary stroke centers. 
Note: A higher percentage is better.
The graph above shows Stroke Performance Measures as follows:
| Quarter | 2009 Q1 | 2009 Q2 | 2009 Q3 | 2009 Q4 | 2010 Q1 | 2010 Q2 |
|---|---|---|---|---|---|---|
| DVT Prophylaxis | 100% | 100% | 100% | 99% | 100% | 100% |
| Discharge on Anticoagulation for patients with atrial fibrillation | 100% | 100% | 100% | 100% | 100% | 100% |
| IV tPA Within 3 Hours of Symptom Onset | 100% | 92% | 100% | 100% | 50% | 92% |
| Antithrombotics by Day 2 | 100% | 100% | 100% | 100% | 99% | 100% |
| Antithrombotics at Discharge | 100% | 100% | 100% | 100% | 100% | 100% |
| Discharged on cholesterol-reducing medication | 99% | 100% | 100% | 95% | 98% | 100% |
| Dysphagia screening | 79% | 75% | 95% | 82% | 90% | 88% |
| Stroke education | 96% | 85% | 98% | 85% | 91% | 93% |
| Smoking cessation | 100% | 100% | 100% | 100% | 100% | 100% |
| Assessed for rehabilitation | 100% | 98% | 100% | 100% | 100% | 100% |
DVT Prophylaxis
What are we measuring? The percentage of patients with ischemic or hemorrhagic stroke that received preventative measures to avoid blood clots forming in their legs (deep vein thrombosis).
Why is this important? Patients who suffer strokes and do not move or walk around are at risk for developing blood clots in their legs. This measure looks at our efforts to reduce that risk.
Discharge on Anticoagulation for patients with atrial fibrillation
What are we measuring? The percentage of ischemic stroke patients with atrial fibrillation that left the hospital on anticoagulation therapy.
Why is this important? Atrial fibrillation is a common arrhythmia (irregular heartbeat) and is one of the leading causes of stroke. Studies have shown that the risk of stroke was lowered by 68% for atrial fibrillation patients treated with warfarin ("blood thinner" medication). Warfarin and other "blood thinner" medications are effective in preventing strokes from occuring again.
IV tPA Within 3 Hours of Symptom Onset
What are we measuring? The percentage of ischemic stroke patients who arrive at the hospital within 2 hours of the first symptoms of stroke, and who are given IV tPA within 3 hours of the first symptoms.
Why is this important? tPA is the "clot-busting" drug that can potentially reverse the effects of a major stroke. It must be given within 3 hours of the start of symptoms to be most effective.
Antithrombotics by Day 2
What are we measuring? The percentage of ischemic stroke patients given antithrombotics by the end of their second day in the hospital.
Why is this important? Studies have suggested that antithrombotics (medications that reduce the formation of blood clots) should be given within 48 hours of the first symptoms of ischemic stroke to lower the risk of stroke-related morbidity (rate of illness) and mortality (rate of death).
Antithrombotics at Discharge
What are we measuring? The percentage of ischemic stroke patients prescribed antithrombotics at discharge.
Why is this important? Studies have suggested that antithrombotics (medications that reduce the formation of blood clots) should be prescribed at discharge following ischemic stroke to lower the risk of future strokes and stroke-related morbidity (rate of illness) and mortality (rate of death).
Discharged on cholesterol-reducing medication
What are we measuring? The percentage of ischemic stroke patients with an LDL ("bad" cholesterol) level greater than 100, an LDL not measured, or who were on cholesterol-lowering therapy before hospitalization, that are discharged from the hospital on statins (cholesterol-lowering drugs).
Why is this important? A high serum lipid level is a risk factor for coronary artery disease. Studies have shown that intensive lipid-lowering therapy using statin medication can dramatically lower the chances of future strokes and heart attacks.
Smoking Cessation
What are we measuring? The percentage of patients with ischemic or hemorrhagic stroke with a history of smoking cigarettes, or their caregivers, who are given smoking cessation advice or counseling during their hospital stay.
Why is this important? Smoking nearly doubles the risk of ischemic stroke. Studies have shown a large drop in the risk of stroke for former smokers, as well as the death rate from coronary heart disease.
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