Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports (NQF 0246)

eMeasure Name Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports eMeasure Id BECF2150-CB97-4421-BF3C-515D71F80A6B
Version number 1 eMeasure Set Id 3E4E04E3-51A0-4F36-B0AE-2C4EF2089033
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of final reports for CT or MRI studies of the brain performed either: In the hospital within 24 hours of arrival, OR In an outpatient imaging center to confirm initial diagnosis of stroke, TIA or intracranial hemmorhage For patients aged 18 years and older with either a diagnosis of ischemic stroke or transient ischemic attack (TIA) or intracranial hemorrhage OR at least one documented symptom consistent with ischemic stroke or TIA or intracranial hemorrhage that includes documentation of the presence or absence of each of the following: hemorrhage and mass lesion and acute infarction
Copyright
© 2010 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
The CT and MRI findings are critical to initiating care for the patient with stroke. All CT and MRI reports should address the presence or absence of these three important findings. This documentation is particularly vital in the report of the first imaging study performed after arrival at the hospital (whether or not the patient is admitted), on which initial treatment decisions will be based. The denominator language and specifications also allow for inclusion of CT or MRI studies performed in an outpatient imaging center to confirm initial diagnosis of stroke, TIA or intracranial hemorrhage (i.e., not including follow-up studies performed after acute treatment for these diagnoses), regardless of whether the patient is subsequently referred to the hospital.
Clinical Recommendation Statement
Brain imaging is required to guide acute intervention. There is a uniform agreement that CT accurately identifies most cases of intracranial hemorrhage and helps discriminate nonvascular causes of neurological symptoms, e.g., brain tumor. With the advent of rtPA treatment, interest has grown in using CT to identify subtle, early signs of ischemic brain injury (early infarct signs) or arterial occlusion that might affect decisions about treatment. The presence of these signs is associated with poor outcomes. (ASA, 2006).

A technically adequate head CT scan is required prior to administration of thrombolytic therapy to exclude brain hemorrhage and nonischemic diagnoses. The baseline CT scan is also sensitive for detection of early signs of cerebral infarction. Subtle or limited signs of early infarction on the CT scan are common even within the first 3 h of stroke evolution. Preliminary data suggest that specific MRI profiles may identify patients who are particularly likely to benefit from thrombolytic therapy. New MRI techniques including perfusion-weighted and diffusion-weighted may detect ischemic injury in the first hour and may reveal the extent of reversible and irreversible injury. In addition, MRI appears to be highly sensitive for identification of acute brain hemorrhage. (ACCP, 2001).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Adams HP, Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein RL, et al. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association (ASA). Stroke 2003; 34; 1056-1083.
Reference
Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126;483-512.
Definition
Equivalent terms or synonyms for hemorrhage, mass lesion, or infarction, if documented in the CT or MRI report, would meet the measure
Definition
Initial Patient Population(s): Patient Age: Patients aged 18 years and older before the start of the measurement period.
Diagnosis, Active:  Final reports with a diagnosis of ischemic stroke, or TIA or intracranial hemorrhage during the measurement period OR at least one documented symptom consistent with ischemic stroke or TIA or intracranial hemorrhage.
Diagnostic Study: CT or MRI of brain performed:
 In the hospital within 24 hours of arrival OR 
In an outpatient imaging center to confirm initial diagnosis of stroke, TIA or intracranial hemorrhage during the measurement period.
Definition
Denominator(s): All final reports for CT or MRI studies of the brain performed either: 
In the hospital within 24 hours of arrival 
OR 
In an outpatient imaging center to confirm initial diagnosis of stroke, TIA or intracranial hemorrhage.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Final reports of the initial CT or MRI that include documentation of the presence or absence of each of the following: hemorrhage and mass lesion and acute infarction.
Definition
Denominator Exception(s): N/A
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012