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Measuring the Quality of Care Given to Stroke Patients at Cedars-Sinai

At the Cedars-Sinai Stroke Program, the care given to persons who have had a stroke is measured against the standards created in the Get With the Guidelines program sponsored by the American Heart Association and the American Stroke Association.

The Get with the Guidelines - Stroke program is an in-hospital program designed to improve the treatment given to people who have had an acute stroke. The guidelines are based on the latest scientific research in the treatment of stroke. They focus on quick diagnosis and treatment after a stroke and actions to prevent future strokes.

Currently, more than 1,516 hospitals are participating in the Get With the Guidelines program. They have contributed information on 896,708 patients in 2008.

Cedars-Sinai Earns a Certificate of Distinction for Primary Stroke Centers from The Joint Commission

Cedars-Sinai has earned The Joint Commission's Certificate of Distinction for Primary Stroke Centers. Awarded on Sept. 9, 2008, the certificate shows that Cedars-Sinai provides provides services to meet the unique and specialized needs of stroke patients.

This designation is awarded to primary stroke centers that comply with national standards and guidelines that can significantly improve outcomes for stroke patients.

The Joint Commission's Primary Stroke Center Certification Program was developed in partnership with the American Stroke Association and the Brain Attack Coalition.

There are 47 Primary Stroke Centers in California. The Cedars-Sinai Stroke Center is one of only five Primary Stroke Centers in the Los Angeles area.

Cedars-Sinai Medical Center Recognized with "Get With the Guidelines" Gold Award

The American Heart Association and the American Stroke Association have recognized Cedars-Sinai Medical Center with a Gold (Sustained) Performance Achievement Award in 2008.

This award recognizes Cedars-Sinai's performance over 24 consecutive months. This prestigious award demonstrates 85% compliance with all 10 "Get With The Guidelines" measures.

The data below on stroke patients treated at Cedars-Sinai reflects treatment given to 643 stroke patients discharged during 2008.

Profile of Patients Receiving Stroke Treatment at Cedars-Sinai

The chart below compares the type of patients treated at Cedars-Sinai Medical Center with all patients reported by hospitals nationally participating in the Get With the Guidelines program.

Types of Strokes Treated at Cedars-Sinai Medical Center

Patients treated at Cedars-Sinai Medical Center had one of the following types of strokes:

• Hemorrhagic, where blood leaks from a blood vessel into brain tissue. This type of stroke can take two forms. A Subarachnoid hemorrhage where a blood vessel just outside the brain ruptures. The area of the skull surrounding the brain (the subarachnoid space) quickly fills with blood. The second type is an intracerebral hemorrhage, in which there is bleeding inside the brain that causes a build up of pressure and damage to brain cells.
• Ischemic, where a blood clot shuts off the flow of blood to parts of the brain
• Transient ischemic attacks (TIA)

The chart below compares the percentage of people treated for each type of stroke at Cedars-Sinai and nationally.

Stroke Treatment and Patient Education

Tissue plasminogen activator (tPA) is a clot-busting drugs. Most strokes are caused by blood clots that stop or disrupt the flow of blood to the brain. The drug tPA has been shown to be effective in treating ischemic stroke. Since 1996, tPA has been approved by the U.S. Food and Drug Administration to treat ischemic stroke in the first three hours after the symptoms start. Given promptly, tPA can significantly reduce the effects of stroke. This in turn, helps reduce permanent disability following a stroke.

The chart below shows how often tPA was considered in the treatment of stroke patients at Cedars-Sinai. These data are compared to hospitals nationally.

The faster a blood clot causing a stroke can be broken up, the less damage to the brain. For tPA to be most effective, it needs to be given within a few hours after symptoms begin. The best time to give tPA is within three hours of the time that symptoms appeared. Giving tPA (or other clot-dissolving agents) to a patient is complex. It is done through an intravenous (IV) line in a hospital.

The chart below shows the percentage of patients who had an acute ischemic stroke who were brought to Cedars-Sinai Medical Center within two hours of their first symptoms and who were given IV tPA within three hours of their first symptoms.

Patient education following a stroke can help prevent future strokes. The chart below compares how many Cedars-Sinai patients received education following a stroke compared to hospitals nationally.

Rehabilitation Plans Following a Stroke

A stroke can cause damage to the brain that makes it difficult for a person to return to his or her normal daily activities. Rehabilitation after a stroke can help a person live with any remaining effects of a stroke. It can also help the brain recover more fully. The chart below shows the percentage of stroke patients treated at Cedars-Sinai for whom a rehabilitation plan was considered. These data are compared to hospitals nationally.

Mortality Rate Following a Stroke

Of the patients admitted to Cedars-Sinai Medical Center following a stroke, 7% died while in the hospital. This compares to an average of 6% for other hospitals nationally participating in the Get With the Guidelines program.

It should be noted that a higher percentqage of patients treated at Cedars-Sinai Medical Center had hemorrhagic strokes compared to patients at other "Get With The Guidelines" hospitals. A total of 21% of the patients treated at Cedars-Sinai had that type of stroke. At other "Get With the Guidelines" hospitals, only 15% of the patients treated had hemorrhagic strokes.

Discharge After Treatment for a Stroke

The following chart shows the percentage of patients who were discharged to their own homes (with and without home health care), inpatient rehabilitation, skilled nursing facilities or other places. (Not included in these numbers are patients who were readmitted to the Medical Center or who died.)

Functional Independence Improvements Following Treatment for a Stroke During Inpatient Rehabilitation

A patient's ability to do activities of daily living without help is measured by a tool called the Functional Improvement Measure (FIM) ™ . Using this tool, rehabilitation specialists working with patients can measure their progress from admission through discharge.

The Uniform Data System for Medical Rehabilitation is the national benchmark providing a way to document functional severity and the results of medical rehabilitation. Through the use of the Functional Independence Measure ™ (FIM), clinicians follow changes in functional status from admission to discharge. The FIM contains 18 items that assess severity of disability and level of functional independence on a 7 point scale.

Ratings are performed in the areas of self-care, sphincter control, mobility, communication, and social cognition. Ratings are established by the interdisciplinary team at admission to inpatient rehabilitation and at discharge from inpatient rehabilitation. Outcomes are measured by taking the numeric difference between the admission FIM and the discharge (FIM). FIM scores range from 18 (dependent) to 126 (independent).

The chart below shows the average functional independence score of patients admitted to Cedars-Sinai following a stroke, the improvement in FIM score during treatment and their FIM score at discharge.