Specifications Manual for Joint Commission National Quality Measures (v2019A)

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Measure Information Form
Version 2019A


Stroke (STK)

Set Measures

Set Measure ID Measure Short Name
STK-1 Venous Thromboembolism (VTE Prophylaxis)
STK-10 Assessed for Rehabilitation
STK-2 Discharged on Antithrombotic Therapy
STK-3 Anticoagulation Therapy for Atrial Fibrillation/Flutter
STK-4 Thrombolytic Therapy
STK-5 Antithrombotic Therapy By End of Hospital Day Two
STK-6 Discharged on Statin Medication
STK-8 Stroke Education

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
Health Care Organization Identifier All Records, Patient Population Data File, Hospital Clinical Data File,
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
Measure Category Assignment All Records, Calculation, Transmission, Hospital Clinical Data File, Used in calculation of the Joint Commission's aggregate data and in the transmission of the Hospital Clinical Data file.
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
Measure Category Assignment All Records, Calculation, Transmission, Hospital Clinical Data File

Measure Set Specific Data Elements

Element Name Collected For
Anticoagulation Therapy Prescribed at Discharge STK-3
Antithrombotic Therapy Administered by End of Hospital Day 2 STK-5
Antithrombotic Therapy Prescribed at Discharge STK-2
Arrival Date STK-4, STK-5
Arrival Time STK-4
Assessed for Rehabilitation Services STK-10
Atrial Fibrillation/Flutter STK-3
Clinical Trial STK
Comfort Measures Only STK-1, STK-10, STK-2, STK-3, STK-5, STK-6, STK-8
Date Last Known Well STK-4
Discharge Disposition STK-10, STK-2, STK-3, STK-6, STK-8
ED Patient STK-4
Education Addresses Activation of Emergency Medical System STK-8
Education Addresses Follow-up After Discharge STK-8
Education Addresses Medication Prescribed at Discharge STK-8
Education Addresses Risk Factors for Stroke STK-8
Education Addresses Warning Signs and Symptoms of Stroke STK-8
Elective Carotid Intervention STK
IV Alteplase Initiation STK-4
IV Alteplase Initiation Date STK-4
IV Alteplase Initiation Time STK-4
IV OR IA Alteplase Administered at This Hospital or Within 24 Hours Prior to Arrival STK-5
Last Known Well STK-4
Reason for Extending the Initiation of IV Alteplase STK-4
Reason for No VTE Prophylaxis – Hospital Admission STK-1
Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2 STK-5
Reason for Not Initiating IV Alteplase STK-4
Reason for Not Prescribing Anticoagulation Therapy at Discharge STK-3
Reason for Not Prescribing Antithrombotic Therapy at Discharge STK-2
Reason for Not Prescribing Statin Medication at Discharge STK-6
Reason for Oral Factor Xa Inhibitor STK-1
Statin Medication Prescribed at Discharge STK-6
Time Last Known Well STK-4
VTE Prophylaxis STK-1
VTE Prophylaxis Date STK-1


  Document Name  
Acknowledgement  
Appendix A - 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  
Cover Page for the Joint Commission Manual  
Data Dictionary  
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  

Stroke (STK) Initial Patient Population

The STK measure set is unique in that there are two distinct Initial Patient Populations (or sub-populations) within the measure set, each identified by a specific group of diagnosis codes, or lack thereof. The patients in each sub-population are counted in the Initial Patient Population of multiple measures. Hospitals utilizing STK for Joint Commission certification purposes will be required to use both the Ischemic and Hemorrhagic sub-populations.

The population of the STK measure set is identified using 4 data elements:

  • ICD-10-CM Principal Diagnosis Code
  • Admission Date
  • Birthdate
  • Discharge Date

The following is the STK Initial Patient Population’s measure breakdown:

Measures Initial Patient Population definition
STK-2, 3, 4, 5, and 6 The count of all patients in sub-population 1
STK-1, 8, and 10 The count of all patients in sub-population 1 and 2

STK-1, 2, 3, 4, 5, 6, 8 and 10 are used for TJC Certification program.

Patients admitted to the hospital for inpatient acute care are included in one of the STK ICD sub-populations and are eligible to be sampled if they have:

1 – Ischemic sub-population – Patients with an ICD-10-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1, a Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years and a Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days are included in the STK Initial Patient Population and are eligible to be sampled.

2 – Hemorrhagic sub-population – Patients with an ICD-10-CM Principal Diagnosis Code for hemorrhagic stroke as defined in Appendix A, Table 8.2, a Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years and a Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days are included in the STK Initial Patient Population and are eligible to be sampled.

NOTE: For Joint Commission certification purposes, hospitals will be abstracting and submitting data on all measures in the STK set; therefore, both sub-population 1 (Ischemic patients) and 2 (Hemorrhagic patients) will be identified by the STK Initial Patient Population to be eligible for sampling.

STK Initial Patient Population

Stroke (STK) Initial Patient Population Algorithm Narrative

Variable Key: Patient Age, Initial Patient Population Reject Case Flag, and Length of Stay.

  1. Start STK Initial Patient Population logic sub-routine. Process all cases that have successfully reached the point in the Transmission Data Processing Flow: Clinical which calls this Initial Patient Population Algorithm. Do not process cases that have been rejected before this point in the Transmission Data Processing Flow: Clinical.
  2. Calculate Patient Age. Patient Age, in years, is equal to the Admission Date minus the Birthdate. Use the month and day portion of admission date and birthdate to yield the most accurate age.
  3. Check Patient Age:
    1. If the Patient Age is less than 18 years, the patient is not in the STK Initial Patient Population and is not eligible to be sampled for the STK measure set. Set the Initial Patient Population Reject Case Flag to equal Yes. Return to Transmission Data Processing Flow: Clinical in the Data Transmission section.
    2. If the Patient Age is greater than or equal to 18 years, continue processing and proceed to Length of Stay Calculation.
  4. Calculate the Length of Stay. Length of Stay, in days, is equal to the Discharge Date minus the Admission Date.
  5. Check Length of Stay:
    1. If the Length of Stay is greater than 120 days, the patient is not in the STK Initial Patient Population and is not eligible to be sampled for the STK measure set. Set the Initial Patient Population Reject Case Flag to equal Yes. Return to Transmission Data Processing Flow: Clinical in the Data Transmission section.
    2. If the Length of Stay is less than or equal to 120 days, continue processing and proceed to ICD-10-CM Principal Diagnosis Code Check.
  6. Check ICD-10-CM Principal Diagnosis Code
    1. If the ICD-10-CM Principal Diagnosis Code is on Table 8.1, the patient is in the first Ischemic Stroke sub-population and is eligible to be sampled for the first STK sub-population. Set the Initial Patient Population Reject Case Flag to equal No. Include the patient in the Initial Patient Population for the appropriate measures. Return to Transmission Data Processing Flow: Clinical in the Data Transmission section.
    2. For Joint Commission Only, if submitting data for STK Certification Program: If the ICD-10-CM Principal Diagnosis Code is on Table 8.2, the patient is in the second Hemorrhagic Stroke sub-population and is eligible to be sampled for the second STK sub-population. Set the Initial Patient Population Reject Case Flag to equal No. Include the patient in the Initial Patient Population for the appropriate measures. Return to Transmission Data Processing Flow: Clinical in the Data Transmission section.

STK 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/month for the sub-population cannot sample that sub-population. Hospitals utilizing this measure set with the Joint Commission for certification purposes and have five or fewer discharges for the two combined STK sub-populations (both Medicare and non-Medicare combined) in a quarter are not required to submit STK patient level data to 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

A modified sampling procedure is required for hospitals performing quarterly sampling for STK. The measure set contains two independent sub-populations: Ischemic STK patients and Hemorrhagic STK patients. The two sub-populations must be sampled independently from each other.

Joint Commission certification purposes: To determine if a hospital may choose to not submit STK patient level data, the count of the discharges, for the quarter, for the two sub-populations must be five or less (i.e., the combined count of discharges equals the count of all patients in the Ischemic Patient Sub-population [1] plus the count of all patients in the Hemorrhagic Patient Sub-population [2].

1.Hospitals selecting sample cases for the Ischemic sub-population must ensure that its Initial Patient Population and sample size for the Ischemic sub-population meets the following conditions:

Quarterly Sample Size
Based on Initial Patient Population Size
for Ischemic Patient Sub-Population
Hospital’s Measure

Average Quarterly
Initial Patient Population
“N”
Minimum Required
Sample Size
“n”
≥ 900 180
226-899 20% of the Initial Patient Population
45-225 45
6 - 44 No sampling; 100% of the Initial Patient Population is required
0 - 5 Submission of patient level data is not required;
if submission occurs, 100% Initial Patient Population required.

2.Hospitals submitting STK data for Joint Commission certification purposes will select sample cases for the Hemorrhagic sub-population, ensuring that its Initial Patient Population and sample size for the Hemorrhagic sub-population meets the following conditions:

Quarterly Sample Size
Based on Initial Patient Population Size
for Hemorrhagic Patient Sub-Population
Hospital’s Measure

Average Quarterly
Initial Patient Population
“N”
Minimum Required
Sample Size
“n”
≥ 900 180
226-899 20% of the Initial Patient Population
45-225 45
6 - 44 No sampling; 100% of the Initial Patient Population is required
0 - 5 Submission of patient level data is not required;
if submission occurs, 100% Initial Patient Population required.

Monthly Sampling A modified sampling procedure is required for hospitals performing monthly sampling for STK. The measure set contains two independent sub-populations: Ischemic STK patients and Hemorrhagic STK patients. The two sub-populations must be sampled independently from each other.

1. Hospitals selecting sample cases for the Ischemic sub-population must ensure that its Initial Patient Population and sample size for the Ischemic sub-population meets the following conditions:

Monthly Sample Size
Based on Initial Patient Population Size
for Ischemic Patient Sub-Population
Hospital’s Measure

Average Monthly
Initial Patient Population
“N”
Minimum Required
Sample Size
“n”
≥ 300 60
76-299 20% of the Initial Patient Population
15-75 15
< 15 No sampling; 100% Initial Patient Population required

2. Hospitals submitting STK data for Joint Commission certification purposes will select sample cases for the Hemorrhagic sub-population, ensuring that its Initial Patient Population and sample size for the Hemorrhagic sub-population meets the following conditions:

Monthly Sample Size
Based on Initial Patient Population Size
for Hemorrhagic Patient Sub-Population
Hospital’s Measure

Average Monthly
Initial Patient Population
“N”
Minimum Required
Sample Size
“n”
≥ 300 60
76-299 20% of the Initial Patient Population
15-75 15
< 15 No sampling; 100% Initial Patient Population required

Sample Size Examples
Note: Hospitals utilizing STK for Joint Commission certification purposes must include all sampled STK sub-populations in the calculation of all STK measures. All of the STK measures’ specific exclusion criteria are used to filter out cases that do not belong in the measure denominator.

Quarterly sampling
  • Quarterly sampling for the Ischemic sub-population:
    • A hospital’s Ischemic sub-population is 392 during the first quarter. Using the quarterly sampling table for the Ischemic sub-population, the sample size required is 20% of this sub-population, or 79 cases for the quarter (twenty percent of 392 equals 78.4 rounded up to the next whole number equals 79)
    • A hospital’s Ischemic sub-population is 100 during the first quarter. The required quarterly sample is 45 cases.
    • If the hospital chooses to submit patient level data: A hospital’s Ischemic sub-population is 5 patients during the first quarter. Using the quarterly sampling table for the Ischemic sub-population, the sample size is less than the minimum required quarterly sample size, so 100% of this sub-population is sampled.
  • Quarterly sampling for the Hemorrhagic sub-population for Joint Commission certification purposes:
    • A hospital’s Hemorrhagic sub-population is 392 during the first quarter. Using the quarterly sampling table for the Hemorrhagic sub-population, the sample size required is 20% of this sub-population, or 79 cases for the quarter (twenty percent of 392 equals 78.4 rounded up to the next whole number equals 79).
    • A hospital’s Hemorrhagic sub-population is 3 patients during the first quarter. Using the quarterly sampling table for the Hemorrhagic sub-population, the sample size is less than the minimum required quarterly sample size, so 100% of this sub-population is sampled.
    • A hospital’s Hemorrhagic sub-population is 100 during the first quarter. The required quarterly sample is 45 cases.
  • Quarterly sampling for the two combined populations for Joint Commission certification purposes.
    • The STK Initial Patient Population sizes for a hospital are 392 and 5 patients respectively per the sub-populations for the quarter. Since the total Initial Patient Population for STK is 397, the hospital must submit patient level data. The required quarterly sample sizes for each sub-population would be 79 and 5.
      • The Ischemic sub-population has 392 patients per quarter, which requires a 20% sample size, or 79 cases (twenty percent of 392 equals 78.4 rounded to the next highest whole number equals 79).
      • The Hemorrhagic sub-population is less than the minimum required quarterly sample size, so 100% of this sub-population is sampled.
    • The STK Initial Patient Population sizes for a hospital are 1 and 3 patients respectively per the sub-populations for the quarter. Since the total Initial Patient Population for STK is 4, the hospital may choose to not submit patient level data. If the hospital chooses to submit patient level data:
      • The Joint Commission: the required quarterly sample size would be 100% of the patient population or 4 cases for the quarter.

Monthly Sampling
  • Monthly sampling for the Ischemic sub-population:
    • A hospital’s Ischemic sub-population is 228 during March. Using the monthly sampling table for the Ischemic sub-population, the sample size required is 20% of this sub-population, or 46 cases for the quarter (twenty percent of 228 equals 45.6 rounded up to the next whole number equals 46).
    • A hospital’s Ischemic sub-population is 316 during January. The required quarterly sample is 60 cases.
    • A hospital’s Ischemic sub-population is 5 patients during February. Using the monthly sampling table for the Ischemic sub-population, the sample size is less than the minimum required monthly sample size, so 100% of this sub-population is sampled.
  • Monthly sampling for the Hemorrhagic sub-population for Joint Commission certification purposes:
    • A hospital’s Hemorrhagic sub-population is 228 during March. Using the monthly sampling table for the Hemorrhagic sub-population, the sample size required is 20% of this sub-population, or 46 cases for the quarter (twenty percent of 228 equals 45.6 rounded up to the next whole number equals 46).
    • A hospital’s Hemorrhagic sub-population is 3 patients during January. Using the monthly sampling table for the Hemorrhagic sub-population, the sample size is less than the minimum required quarterly sample size, so 100% of this sub-population is sampled.
    • A hospital’s Hemorrhagic sub-population is 316 during February. The required monthly sample is 60 cases.

Measure Information Form STK
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Specifications Manual for Joint Commission National Quality Measures (v2019A)
Discharges 07-01-19 (3Q19) through 12-31-19 (4Q19)

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