Specifications Manual for Joint Commission National Quality Measures (v2018B1)

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Release Notes:
Measure Information Form
Version 2018B1

**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Stroke (STK)

Set Measure ID: STK-6

Performance Measure Name: Discharged on Statin Medication

Description: Ischemic stroke patients who are prescribed statin medication at hospital discharge.

Rationale: There is an extensive and consistent body of evidence supporting the use of statins for secondary prevention in patients with clinically evident atherosclerotic cardiovascular disease (ASCVD), which includes individuals with ischemic stroke due to large artery atherosclerosis, individuals with ischemic stroke due to intrinsic small vessel disease, and individuals with ischemic stroke not directly due to atherosclerosis but with clinically evident atherosclerotic disease in an uninvolved cerebral or noncerebral bed. Both women and men with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death. High-intensity statin therapy should be initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical ASCVD, unless contraindicated. In patients with clinical ASCVD and a contraindication to high-intensity statin therapy, moderate-intensity therapy should be considered as an alternative if it can be tolerated. In individuals greater than 75 years of age, the potential for ASCVD risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences should be considered, and statin therapy individualized based on these considerations (Stone, 2013).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Ischemic stroke patients prescribed statin medication at hospital discharge.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Ischemic stroke patients
Included Populations: Discharges with an ICD-10-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who have a Length of Stay greater than 120 days
  • Patients with Comfort Measures Only documented
  • Patients enrolled in clinical trials
  • Patients admitted for Elective Carotid Intervention
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
  • Patients with a Reason for Not Prescribing Statin Medication at Discharge

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical record documents. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:
  • Amarenco, P., J. Bogousslavsky, A. Callahan, 3rd, L. B. Goldstein, M. Hennerici, A. E. Rudolph, H. Sillesen, et al. "High-Dose Atorvastatin after Stroke or Transient Ischemic Attack." [In eng]. N Engl J Med 355, no. 6 (Aug 10 2006): 549-59.
  • Biffi, A., W. J. Devan, C. D. Anderson, L. Cortellini, K. L. Furie, J. Rosand, and N. S. Rost. "Statin Treatment and Functional Outcome after Ischemic Stroke: Case-Control and Meta-Analysis." [In eng]. Stroke 42, no. 5 (May 2011): 1314-9.
  • Centers for Disease Control and Prevention. "Prevalence and Most Common Causes of Disability among Adults--United States, 2005." [In eng]. MMWR Morb Mortal Wkly Rep 58, no. 16 (May 1 2009): 421-6.
  • Chan, P. S., B. K. Nallamothu, H. S. Gurm, R. A. Hayward, and S. Vijan. "Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients with Coronary Artery Disease." [In eng]. Circulation 115, no. 18 (May 8 2007): 2398-409.
  • Culver, A. L., I. S. Ockene, R. Balasubramanian, B. C. Olendzki, D. M. Sepavich, J. Wactawski-Wende, J. E. Manson, et al. "Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative." [In eng]. Arch Intern Med 172, no. 2 (Jan 23 2012): 144-52.
  • Feher, A., G. Pusch, K. Koltai, A. Tibold, B. Gasztonyi, L. Szapary, and G. Feher. "Statintherapy in the Primary and the Secondary Prevention of Ischaemic Cerebrovascular Diseases." [In eng]. Int J Cardiol 148, no. 2 (Apr 14 2011): 131-8.
  • Grundy, S. M., J. I. Cleeman, C. N. Merz, H. B. Brewer, Jr., L. T. Clark, D. B. Hunninghake, R. C. Pasternak, et al. "Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines." [In eng]. Circulation 110, no. 2 (Jul 13 2004): 227-39.
  • Kernan, W.N., B. Ovbiagele, H. R. Black, D. M. Bravata, M. I. Chimowitz, M. D. Ezekowitz, M. C. Fang, M. Fisher, K. L. Furie, D. V. Heck, S. C. Johnston, S. E. Kasner, S. J. Kittner, P. H. Mitchell, M. W. Rich, D. Richardson, L. H. Schwamm, J. A. Wilson. “Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.” [in eng.] Stroke 45, no. 7 (May 2014): 2160-223.
  • Kostis, W. J., J. Q. Cheng, J. M. Dobrzynski, J. Cabrera, and J. B. Kostis. "Meta-Analysis of Statin Effects in Women Versus Men." [In eng]. J Am Coll Cardiol 59, no. 6 (Feb 7 2012): 572-82.
  • Lazar, L. D., M. J. Pletcher, P. G. Coxson, K. Bibbins-Domingo, and L. Goldman. "Cost-Effectiveness of Statin Therapy for Primary Prevention in a Low-Cost Statin Era." [In eng]. Circulation 124, no. 2 (Jul 12 2011): 146-53.
  • Mitka, M. "Some Question Use of Statins to Reduce Cardiovascular Risks in Healthy Women." [In eng]. JAMA 307, no. 9 (Mar 7 2012): 893-4.
  • National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults."Third Report of the National Cholesterol Education Program (Ncep) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Iii) Final Report." [In eng]. Circulation 106, no. 25 (Dec 17 2002): 3143-421.
  • Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, et al; on behalf of the American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Jan;49:e44, e47.
  • Rodriguez-Yanez, M., J. Agulla, R. Rodriguez-Gonzalez, T. Sobrino, and J. Castillo. "Statins and Stroke." [In eng]. Ther Adv Cardiovasc Dis 2, no. 3 (Jun 2008): 157-66.
  • Roger, V. L., A. S. Go, D. M. Lloyd-Jones, E. J. Benjamin, J. D. Berry, W. B. Borden, D. M. Bravata, et al. "Heart Disease and Stroke Statistics--2012 Update: A Report from the American Heart Association." [In eng]. Circulation 125, no. 1 (Jan 3 2012): e2-e220.
  • Schellinger, P. D., R. N. Bryan, L. R. Caplan, J. A. Detre, R. R. Edelman, C. Jaigobin, C. S. Kidwell, et al. "Evidence-Based Guideline: The Role of Diffusion and Perfusion MRI for the Diagnosis of Acute Ischemic Stroke: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology." [In eng]. Neurology 75, no. 2 (Jul 13 2010): 177-85.
  • Squizzato, A., E. Romualdi, F. Dentali, and W. Ageno. "Statins for Acute Ischemic Stroke." [In eng]. Cochrane Database Syst Rev, no. 8 (2011): CD007551.
  • Stone NJ, Robinson J, Lichtenstein AH, Noel Bairey Merz C, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero Jr, ST, Smith SC, Watson K, Wilson PWF. “Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. [In eng]. Circulation 11, (Nov 2013): 1-84.
  • Van Dis, F. J., L. M. Keilson, C. A. Rundell, and M. W. Rawstron. "Direct Measurement of Serum Low-Density Lipoprotein Cholesterol in Patients with Acute Myocardial Infarction on Admission to the Emergency Room." [In eng]. Am J Cardiol 77, no. 14 (Jun 1 1996): 1232-4.
  • Weiss, R., M. Harder, and J. Rowe. "The Relationship between Nonfasting and Fasting Lipid Measurements in Patients with or without Type 2 Diabetes Mellitus Receiving Treatment with 3-Hydroxy-3-Methylglutaryl-Coenzyme a Reductase Inhibitors." [In eng]. Clin Ther 25, no. 5 (May 2003): 1490-7.

Measure Algorithm:

Measure Information Form STK-6
Specifications Manual for Joint Commission National Quality Measures (v2018B1)
Discharges 01-01-19 (1Q19) through 06-30-19 (2Q19)

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