Specifications Manual for Joint Commission National Quality Measures (v2018A1)
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Measure Information Form
Version 2018A1


Comprehensive Stroke (CSTK)

Set Measures

Set Measure ID Measure Short Name
CSTK-01 National Institutes of Health Stroke Scale (NIHSS Score Performed for Ischemic Stroke Patients)
CSTK-02 Modified Rankin Score (mRS at 90 Days)
CSTK-03 Severity Measurement Performed for SAH and ICH Patients (Overall Rate)
CSTK-04 Procoagulant Reversal Agent Initiation for Intracerebral Hemorrhage (ICH )
CSTK-05 Hemorrhagic Transformation (Overall Rate)
CSTK-06 Nimodipine Treatment Administered
CSTK-07 Median Time to Revascularization
CSTK-08 Thrombolysis in Cerebral Infarction (TICI Post-Treatment Reperfusion Grade)
CSTK-09 Arrival Time to Skin Puncture
CSTK-10 Modified Rankin Score (mRS at 90 Days: Favorable Outcome)
CSTK-11 Timeliness of Reperfusion: Arrival Time to TICI 2B or Higher
CSTK-12 Timeliness of Reperfusion: Skin Puncture to TICI 2B or Higher

General Data Elements

Element Name Collected For
Admission Date All Records,
Birthdate All Records,
Discharge Date All Records, Not collected for HBIPS-2 and HBIPS-3
Hispanic Ethnicity All Records,
ICD-10-CM Other Diagnosis Codes All Records, Optional for HBIPS-2, HBIPS-3
ICD-10-CM Principal Diagnosis Code All Records, Optional for HBIPS-2, HBIPS-3
ICD-10-PCS Other Procedure Codes All Records, Optional for All HBIPS Records
ICD-10-PCS Other Procedure Dates All Records, Optional for All HBIPS Records
ICD-10-PCS Principal Procedure Code All Records, Optional for All HBIPS Records
ICD-10-PCS Principal Procedure Date All Records, Optional for All HBIPS Records
Payment Source All Records, Optional for HBIPS-2 and HBIPS-3
Race All Records,
Sex All Records,

Algorithm Output Data Elements

Element Name Collected For
Measurement Value Calculation, Transmission, Hospital Clinical Data File

Measure Set Specific Data Elements

Element Name Collected For
Admitting Diagnosis CSTK-04,
Arrival Date CSTK-01, CSTK-03, CSTK-05, CSTK-06, CSTK-07, CSTK-09, CSTK-11,
Arrival Time CSTK-01, CSTK-03, CSTK-05, CSTK-06, CSTK-07, CSTK-09, CSTK-11,
Clinical Trial CSTK-04, CSTK-06,
Comfort Measures Only CSTK-01, CSTK-03, CSTK-04, CSTK-06,
Delayed Endovascular Rescue Procedure CSTK-09, CSTK-11,
Direct Admission CSTK-01, CSTK-03,
Discharge Disposition CSTK-02, CSTK-10,
Discharge Time CSTK-01, CSTK-03, CSTK-06,
ED Patient CSTK-01, CSTK-03,
Elective Carotid Intervention CSTK-01, CSTK-02, CSTK-05, CSTK-07, CSTK-08, CSTK-09, CSTK-10, CSTK-11, CSTK-12,
Failed Attempt at Thrombectomy CSTK-08, CSTK-11, CSTK-12,
First Pass Date CSTK-07,
First Pass Time CSTK-07,
First Pass of a Mechanical Reperfusion Device CSTK-07,
Highest NIHSS Score Documented Within 36 Hours Following IA t-PA or MER Initiation CSTK-05,
Highest NIHSS Score Documented Within 36 Hours Following IV Thrombolytic Initiation CSTK-05,
IA Route of t-PA Administration CSTK-05, CSTK-07, CSTK-08, CSTK-09,
IA Thrombolytic Initiation CSTK-07,
IA Thrombolytic Initiation Date CSTK-07,
IA Thrombolytic Initiation Time CSTK-07,
IA t-PA or MER Initiation Date CSTK-05,
IA t-PA or MER Initiation Time CSTK-05,
ICD-10-PCS Other Procedure Times CSTK-01, CSTK-03,
ICD-10-PCS Principal Procedure Time CSTK-01, CSTK-03,
INR Value > 1.4 CSTK-04,
IV Thrombolytic Initiation CSTK-05,
IV Thrombolytic Initiation Date CSTK-05,
IV Thrombolytic Initiation Time CSTK-05,
IV Thrombolytic Therapy Prior to IA or Mechanical Reperfusion Therapy CSTK-05, CSTK-08, CSTK-10,
Initial Blood Glucose Value at Hospital Arrival CSTK-05, CSTK-08, CSTK-10,
Initial Blood Pressure at Hospital Arrival CSTK-05, CSTK-08, CSTK-10,
Initial Hunt and Hess Scale Date CSTK-03,
Initial Hunt and Hess Scale Performed CSTK-03,
Initial Hunt and Hess Scale Time CSTK-03,
Initial ICH Score Date CSTK-03,
Initial ICH Score Performed CSTK-03,
Initial ICH Score Time CSTK-03,
Initial NIHSS Score Date CSTK-01,
Initial NIHSS Score Performed CSTK-01,
Initial NIHSS Score Time CSTK-01,
Initial NIHSS Score at Hospital Arrival CSTK-05, CSTK-08, CSTK-10,
Initial Platelet Count at Hospital Arrival CSTK-05, CSTK-08, CSTK-10,
Modified Rankin Score (mRS) CSTK-02, CSTK-10,
Modified Rankin Score (mRS) Date CSTK-02, CSTK-10,
NIHSS Score Documented Closest to IA t-PA or MER Initiation CSTK-05,
NIHSS Score Documented Closest to IV Thrombolytic Initiation CSTK-05,
Nimodipine Administration CSTK-06,
Nimodipine Administration Date CSTK-06,
Nimodipine Administration Time CSTK-06,
Non-aneurysmal CSTK-03,
Positive Brain Image CSTK-05,
Positive Brain Image Date CSTK-05,
Positive Brain Image Time CSTK-05,
Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade CSTK-08, CSTK-11, CSTK-12,
Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade Date CSTK-11, CSTK-12,
Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade Time CSTK-11, CSTK-12,
Procoagulant Reversal Agent Initiation CSTK-04,
Proximal or Distal Occlusion CSTK-08,
Reason for Not Administering Nimodipine Treatment CSTK-06,
Reason for Not Administering a Procoagulant Reversal Agent CSTK-04,
Site of Primary Vessel Occlusion CSTK-08, CSTK-11, CSTK-12,
Skin Puncture CSTK-09, CSTK-12,
Skin Puncture Date CSTK-09, CSTK-12,
Skin Puncture Time CSTK-09, CSTK-12,


  Document Name  
Acknowledgment and Conditions of Use  
Appendix A - ICD-10 Code Tables  
Appendix C - Medication Tables  
Appendix D - Glossary of Terms  
Appendix E - Overview of Measure Information Form and Flowchart Formats  
Appendix G - Resources  
Appendix H - Miscellaneous Tables  
Data Dictionary  
Cover Page for the Joint Commission Manual  
Introduction to the Manual  
Missing and Invalid Data  
Sampling  
Table of Contents  
Transmission Alpha Data Dictionary  
Transmission Data Processing Flow: Clinical  
Transmission Data Processing Flow: Population and Sampling  
Transmission of Data  
Using the The Joint Commission's National Measure Specifications Manual  

Comprehensive Stroke (CSTK) Initial Patient Population

The CSTK Initial Patient Population is unique in that it is comprised of three distinct subpopulations: ischemic stroke patients who do not undergo a reperfusion therapy (i.e., procedure), ischemic stroke patients who undergo a reperfusion therapy (IV t-PA, IA t-PA, or mechanical endovascular reperfusion (MER) therapy), and hemorrhagic stroke patients.

Ischemic Stroke
The population of the CSTK 1-Ischemic Stroke measures (CSTK-01) are identified using 4 data elements:
  • Admission Date
  • Birthdate
  • Discharge Date
  • ICD-10-CM-Principal Diagnosis Code

Patients admitted to the hospital for inpatient acute care are included in the CSTK 1-Ischemic Stroke Without Procedure subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1, a Patient Age (Admission Date – Birthdate) ≥ 18 years and a Length of Stay (Discharge Date - Admission Date) ≤ 120 days.

Note: Hospitals are NOT required to sample their data. If sampling offers minimal benefit (i.e., a hospital has 45 cases for the quarter and must select a sample of 42 cases), the hospital may choose to use all cases.

Ischemic Stroke With IV t-PA, IA t-PA, or MER
The population of the CSTK 2-Ischemic Stroke With IV t-PA, IA t-PA, or MER measures (CSTK-01, CSTK-02, CSTK-05, CSTK-07, CSTK-08, CSTK-09, CSTK-10, CSTK-11, CSTK-12) are identified using 5 data elements:
  • Admission Date
  • Birthdate
  • Discharge Date
  • ICD-10-CM Principal Diagnosis Code
  • ICD-10-PCS Principal or Other Procedure Codes

Patients admitted to the hospital for inpatient acute care are included in the CSTK-2 Ischemic Stroke With IV t-PA, IA t-PA, or MER subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1 AND ICD-10-PCS Principal or Other Procedure Codes as defined in Appendix A, Table 8.1a OR Table 8.1b, a Patient Age (Admission Date – Birthdate) ≥ 18 years and a Length of Stay (Discharge Date - Admission Date) ≤ 120 days.

Note: Hospitals are NOT required to sample their data. If sampling offers minimal benefit (i.e., a hospital has 45 cases for the quarter and must select a sample of 42 cases), the hospital may choose to use all cases.

Hemorrhagic Stroke
The population of the CSTK 3-Hemorrhagic Stroke measures (CSTK-03, CSTK-04, CSTK-06) are identified using 4 data elements:
  • Admission Date
  • Birthdate
  • Discharge Date
  • ICD-10-CM-Principal Diagnosis Code

Patients admitted to the hospital for inpatient acute care are included in the CSTK 3-Hemorrhagic Stroke subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.2, a Patient Age (Admission Date – Birthdate) ≥ 18 years and a Length of Stay (Discharge Date - Admission Date) ≤ 120 days.

Note: Hospitals are NOT required to sample their data. If sampling offers minimal benefit (i.e., a hospital has 80 cases for the quarter and must select a sample of 75 cases), the hospital may choose to use all cases.

CSTK_initial_pop_pg1.jpg v3 CSTK_initial_pop_pg2.jpg v3


CSTK Sample Size Requirements

Hospitals that choose to sample have the option of sampling quarterly or sampling monthly. A hospital may choose to use a larger sample size than is required. Hospitals whose Initial Patient Population size is less than the minimum number of cases per quarter for the measure set cannot sample. Hospitals that have five or fewer CSTK discharges (both Medicare and non-Medicare combined) in a quarter are not required to submit CSTK patient level data to the QIO Clinical Warehouse or the Joint Commission’s Data Warehouse.

Regardless of the option used, hospital samples must be monitored to ensure that sampling procedures consistently produce statistically valid and useful data. Due to exclusions, hospitals selecting sample cases MUST submit AT LEAST the minimum required sample size.

The following sample size tables for each option automatically build in the number of cases needed to obtain the required sample sizes. For information concerning how to perform sampling, refer to the Population and Sampling Specifications section in this manual.

Quarterly Sampling

Hospitals performing quarterly sampling for CSTK must ensure that its Initial Patient Population and sample size meet the following conditions for each sampling group:

Quarterly Sample Size
Based on CSTK Subpopulation 1 for Ischemic Stroke Without Procedure
(CSTK-01 Measure)

Hospital’s Measure (Table 1)
Average Quarterly
Initial Patient Population Size "N"
Minimum Required
Sample Size "n"
> 420 84
211-419 20% of Patient Population size
43-210 42
≤ 42 No sampling; 100% Patient Population required

Quarterly Sample Size
Based on CSTK Subpopulation 2 for Ischemic Stroke With IV t-PA, IA t-PA,or MER
(CSTK-01, CSTK-02, CSTK-05, CSTK-07, CSTK-08, CSTK-09, CSTK-10, CSTK-11, CSTK-12)

Hospital’s Measure (Table 2)
Average Quarterly
Initial Patient Population Size "N"
Minimum Required
Sample Size "n"
> 420 84
211-419 20% of Patient Population size
43-210 42
≤ 42 No sampling; 100% Patient Population required

Quarterly Sample Size
Based on CSTK Subpopulation 3 for Hemorrhagic Stroke
(CSTK-03, CSTK-04, CSTK-06)

Hospital’s Measure (Table 3)
Average Quarterly
Initial Patient Population Size "N"
Minimum Required
Sample Size "n"
> 750 150
376-750 20% of Patient Population size
76-375 75
≤ 75 No sampling; 100% Patient Population required

Monthly Sampling

Hospitals performing monthly sampling for CSTK must ensure that its Initial Patient Population and sample size meet the following conditions for each sampling group:

Monthly Sample Size
Based on CSTK Subpopulation 1 for Ischemic Stroke Without Procedure
(CSTK-01 Measure)
Hospital’s Measure (Table 4)
Average Monthly
Initial Patient Population Size "N"
Minimum Required
Sample Size "n"
> 140 28
71-140 20% of Patient Population size
15-70 14
≤ 14 No sampling; 100% Patient Population required
Monthly Sample Size
Based on CSTK Subpopulation 2 for Ischemic Stroke With IV t-PA, IA t-PA, or MER
(CSTK-01, CSTK-02, CSTK-05, CSTK-07, CSTK-08, CSTK-09, CSTK-10, CSTK-11, CSTK-12)
Hospital’s Measure (Table 5)
Average Monthly
Initial Patient Population Size "N"
Minimum Required
Sample Size "n"
> 140 28
71-140 20% of Patient Population size
15-70 14
≤ 14 No sampling; 100% Patient Population required



Monthly Sample Size
Based on CSTK Subpopulation 3 for Hemorrhagic Stroke
(CSTK-03, CSTK-04, CSTK-06)
Hospital’s Measure (Table 6)
Average Monthly
Initial Patient Population Size "N"
Minimum Required
Sample Size "n"
> 250 50
126-250 20% of Patient Population size
26-125 25
≤ 25 No sampling; 100% Patient Population required

Sample Size Examples

NOTE: Two subpopulations make-up the population for the CSTK-01 measure; CSTK Subpopulation 1 for Ischemic Stroke Without Procedure and CSTK Subpopulation 2 for Ischemic Stroke With IV t-PA, IA t-PA, or MER. Both sampling groups must be sampled to meet the minimum sampling requirement for CSTK-01.
Examples:
  • A hospital’s ischemic stroke patient population size is 200 patients during the second quarter. Fifty (50) ischemic stroke patients had a procedure for thrombolysis or mechanical clot removal. The required quarterly sample size for the CSTK-01 measure is a minimum of 84 cases (42 cases from Table 1 plus 42 cases from Table 2 equals 84).
  • A hospital’s ischemic stroke patient population size is 200 patients during March. Twenty (20) ischemic stroke patients had a procedure for thrombolysis or mechanical clot removal. The required sample size for the CSTK-01 measure is a minimum of 42 cases for the month (28 cases from Table 4 plus 14 cases from Table 5 equals 42).


Quarterly sampling
CSTK Subpopulation 1 for Ischemic Stroke Without Procedure
  • A hospital’s ischemic stroke patient population size is 495 cases during the second quarter. Using the quarterly sampling table for the ischemic stroke subpopulation, the sample size required is 84 cases for the quarter.
  • A hospital’s ischemic stroke patient population size is 392 cases during the second quarter. Using the quarterly sampling table for the ischemic stroke subpopulation, the sample size required is 20% of this subpopulation or 78 cases for the quarter (20% of 392 equals 78.4 rounded to the next highest whole number equals 78).
  • A hospital’s ischemic stroke patient population size is 200 cases during the second quarter. Using the quarterly sampling table for the ischemic stroke subpopulation, the sample size required is 42 cases for the quarter.
  • A hospital’s ischemic stroke patient population size is 37 cases during the second quarter. Using the quarterly sampling table for the ischemic stroke subpopulation, the sample size is less than the minimum required quarterly sample size, so 100% of the subpopulation or all 37 cases are sampled.

CSTK Subpopulation 2 for Ischemic Stroke With IV t-PA, IA t-PA, or MER
  • Four-hundred and twenty-eight (428) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during the second quarter. Using the quarterly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size required is 84 cases for the quarter.
  • Two-hundred and twenty-three (223) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during the second quarter. Using the quarterly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size required is 20% of this subpopulation or 45 cases for the quarter (20% of 223 equals 44.6 rounded to the next highest whole number equals 45).
  • Fifty (50) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during the second quarter. Using the quarterly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size required is 42 cases for the quarter.
  • Nineteen (19) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during the second quarter. Using the quarterly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size is less than the minimum required quarterly sample size, so 100% of the subpopulation or all 19 cases are sampled.

CSTK Subpopulation 3 for Hemorrhagic Stroke
  • A hospital’s hemorrhagic stroke patient population size is 795 cases during the second quarter. Using the quarterly sampling table for the hemorrhagic stroke subpopulation, the sample size required is 150 cases for the quarter.
  • A hospital’s hemorrhagic stroke patient population size is 392 cases during the second quarter. Using the quarterly sampling table for the hemorrhagic stroke subpopulation, the sample size required is 20% of this subpopulation or 78 cases for the quarter (20% of 392 equals 78.4 rounded to the next highest whole number equals 78).
  • A hospital’s hemorrhagic stroke patient population size is 200 cases during the second quarter. Using the quarterly sampling table for the hemorrhagic stroke subpopulation, the sample size required is 75 cases for the quarter.
  • A hospital’s hemorrhagic stroke patient population size is 67 cases during the second quarter. Using the quarterly sampling table for the hemorrhagic stroke subpopulation, the sample size is less than the minimum required quarterly sample size, so 100% of the subpopulation or all 67 cases are sampled.


Monthly sampling
CSTK Subpopulation 1 for Ischemic Stroke Without Procedure
  • A hospital’s ischemic stroke patient population size is 295 cases during March. Using the monthly sampling table for the ischemic stroke subpopulation, the sample size required is 28 cases for the month.
  • A hospital’s ischemic stroke patient population size is 129 cases during March. Using the monthly sampling table for the ischemic stroke subpopulation, the sample size required is 20% of this subpopulation or 26 cases for the month (20% of 129 equals 25.8 rounded to the next highest whole number equals 26).
  • A hospital’s ischemic stroke patient population size is 70 cases during March. Using the monthly sampling table for the ischemic stroke subpopulation, the sample size required is 14 cases for the month.
  • A hospital’s ischemic stroke patient population size is 7 cases during March. Using the monthly sampling table for the ischemic stroke subpopulation, the sample size is less than the minimum required monthly sample size, so 100% of the subpopulation or all 7 cases are sampled.

CSTK Subpopulation 2 for Ischemic Stroke With IV t-PA, IA t-PA, or MER
  • One-hundred and forty-eight (148) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during March. Using the monthly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size required is 28 cases for the month.
  • One-hundred and twenty-three (123) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during March. Using the monthly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size required is 20% of this subpopulation or 25 cases for the month (20% of 123 equals 24.6 rounded to the next highest whole number equals 25).
  • Sixty (60) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during March. Using the monthy sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size required is 14 cases for the month.
  • Eleven (11) ischemic stroke cases had IV or IA thrombolysis or a mechanical clot removal procedure during March. Using the monthly sampling table for the ischemic stroke with IV t-PA, IA t-PA or MER subpopulation, the sample size is less than the minimum required monthly sample size, so 100% of the subpopulation or all 11 cases are sampled.

CSTK Subpopulation 3 for Hemorrhagic Stroke
  • A hospital’s hemorrhagic stroke patient population size is 295 cases during March. Using the monthly sampling table for the hemorrhagic stroke subpopulation, the sample size required is 50 cases for the month.
  • A hospital’s hemorrhagic stroke patient population size is 129 cases during March. Using the monthly sampling table for the hemorrhagic stroke subpopulation, the sample size required is 20% of this subpopulation or 26 cases for the month (20% of 129 equals 25.8 rounded to the next highest whole number equals 26).
  • A hospital’s hemorrhagic stroke patient population size is 60 cases during March. Using the monthly sampling table for the hemorrhagic stroke subpopulation, the sample size required is 25 cases for the month.
  • A hospital’s hemorrhagic stroke patient population size is 17 cases during March. Using the monthly sampling table for the hemorrhagic stroke subpopulation, the sample size is less than the minimum required monthly sample size, so 100% of the subpopulation or all 17 cases are sampled.























Measure Information Form CSTK
Specifications Manual for Joint Commission National Quality Measures (v2018A1)
Discharges 07-01-18 (3Q18) through 12-31-18 (4Q18)

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