Specifications Manual for Joint Commission National Quality Measures (v2025A)
Posted: 09/13/2024

Release Notes:
Measure Information Form
Version 2025A

Measure Information Form

Measure Set: Comprehensive Stroke (CSTK)

Set Measure ID: CSTK-06

Performance Measure Name: Nimodipine Treatment Administered

Description: Subarachnoid hemorrhage (SAH) patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital

Rationale: Cerebral vasopasm is a serious complication following SAH, occurring in 30% to 70% of patients and accounting for nearly 50% of the deaths in patients surviving to treatment. Constriction of the arterial lumen results in diminished cerebral perfusion distal to the affected artery, which produces a delayed neurological deficit that may progress to cerebral infarction without early management of the ruptured aneurysm. The arterial narrowing that occurs in cerebral vasospasm is typically a transient or temporary event, lasting from a few days up to 3 weeks. Oral nimodipine is a proven and valuable treatment to prevent or limit the severity of cerebral vasospasm.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: SAH patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital.
Included Populations: As above

Excluded Populations: None

Data Elements:

Denominator Statement: SAH patients
Included Populations: Discharges with ICD-10-CM Principal Diagnosis Code for subarachnoid hemorrhage as defined in Appendix A, Table 8.2a for ICD-10 codes.

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who have a Length of Stay > 120 days
  • Patients with Comfort Measures Only documented on day of or after hospital arrival
  • Patients enrolled in clinical trials
  • Patients discharged within 24 hours of arrival at this hospital

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

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:

1.  Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks E. Guidelines for the Early Management of Adults with Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke. 2007;38:1686.

2.  Allen GS, Ahn HS, Presiosi TJ, Battye R,Boone SC, Cho SN, Kelly DL, Weir BK, Crabbe RA, Lavik PJ, Rosenbloom SB, Dorsey FC, Ingram CR, Mellits DE, Bertsch LA, Boisvert DP, Hundley MB, Johnson RK, Strom JA, Transou CR. Cerebral arterial spasm: a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med. 1983;308:619-624.

3.  Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, and Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009;40:1008-1011.

4.  Fogelholm R, Palomaki H, Erila T, Rissanen A, Kaste M. Blood pressure, nimodipine, and outcome of ischemic stroke. Acta Neurol Scand. 2004;109:200-204.

5.  Haley EC Jr, Kassell NF, Torner JC, Truskowski LL, Germanson TP. A randomized trial of two doses of nicardipine in aneurysmal subarachnoid hemorrhage: a report of the Cooperative Aneurysm Study. J Neurosugr. 1994;80:788-796.

6.  Hoh BL, Ko NU, Amin-Hanjani S, Chou SH-Y, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R; Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023;54:e26-e33. doi: 10.1161/STR.000000000000043.

7.  Kaste M, Fogelholm R, Erila T, Palomaki H, Murros K, Rissanen A, Sarna S. A randomized, double-blinded, placebo-controlled trial of nimodipine in acute ischemic hemispheric stroke. Stroke. 1994;25:1348-1353.

8.  Leifer D, Bravata DM, Connors JJ III, Hinchey JA, Jauch EC, Johnston SC, Latchaw R, Likosky W, Ogilvy C, Qureshi AI, Summers D, Sung GY, Williams LS, Zorowitz R, on behalf of the American Heart Association Special Writing Group of the Stroke Council, Atherosclerotic Peripheral Vascular Disease Working Group and Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular Nursing. Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:863-864.

9.  Mayberg MR, Batjer HH, Dacey R, Diringer M, Haley EC, Heros RC, Sternau LL, Torner J, Adams HP Jr, Feinberg W. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 1994;25:2315-2328.

10.  Toyota BD. The efficacy of an abbreviated course of nimodipine in patients with good grade aneurysmal subarachnoid hemorrhage. JNeurosurg. 1999;90(2):203-206.

11.  Wahlgren NG, MacMahon DG, DeKeyser J, Indredavik B, Ryman T. Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischemic stroke. Cerebrovasc Dis. 1994;4:204-210.

12.  The American Nimodipine Study Group. Clinical trial of nimodipine in acute ischemic stroke. Stroke. 1992;23:3-8.

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step. Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

CSTK-06 Nimodipine Treatment Administered Algorithm Narrative

Numerator Statement: SAH patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital.
Denominator Statement: SAH patients.

1. Start processing. Run cases, which are included in the Comprehensive Stoke Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check ICD-10 CM Principal Diagnosis Code
  1. If all ICD-10 CM Principal Diagnosis codes are not on Table 8.2a, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  2. If at least one of the ICD-10 CM Principal Diagnosis codes is on Table 8.2a, continue processing and proceed to check Comfort Measures Only.
3. Check Comfort Measures Only.
  1. If Comfort Measures Only is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Comfort Measures Only equals 1, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Comfort Measures Only equals 2, 3 or 4, continue processing and proceed to check Clinical Trial.
4. Check Clinical Trial
  1. If Clinical Trial is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Clinical Trial equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Clinical Trial equals N, continue processing and proceed to Arrival Date.
5. Check Arrival Date
  1. If Arrival Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Arrival Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Arrival Date is Non-UTD value, continue processing and proceed to check Arrival Time.
6. Check Arrival Time
  1. If Arrival Time is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Arrival Time equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Arrival Time is Non-UTD value, continue processing and proceed to Discharge Time.
7. Check Discharge Time
  1. If Discharge Time is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Discharge Time equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Discharge Time is Non-UTD value, continue processing and proceed to calculate Timing I.
8. Calculate Timing I (in minute). Timing I (in minute) is equal to the Discharge Date and Discharge Time minus Arrival Date and Arrival Time, continue processing and proceed to check Timing I.

9. Check Timing I
  1. If Timing I is less than 0 minutes, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Timing I is greater than or equal to 0 minutes and less than 1440 minutes, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Timing I is greater than or equal to 1440 minutes, the case will proceed to check Nimodipine Administration.
10. Check Nimodipine Administration
  1. If Nimodipine Administration is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Nimodipine Administration equals N, continue processing and proceed to check Step 11 Reason for Not Administering Nimodipine Treatment.
  3. If Nimodipine Administration equals Y, continue processing and proceed to check Step 12 Nimodipine Administration Date.
11. Check Reason for Not Administering Nimodipine Treatment
  1. If Reason for Not Administering Nimodipine Treatment is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Reason for Not Administering Nimodipine Treatment equals Y, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Stop processing.
  3. If Reason for Not Administering Nimodipine Treatment equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
12. Check Nimodipine Administration Date
  1. If Nimodipine Administration Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Nimodipine Administration Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Nimodipine Administration Date is Non-UTD value, continue processing and proceed to check Nimodipine Administration Time.
13. Check Nimodipine Administration Time
  1. If Nimodipine Administration Time is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Nimodipine Administration Time equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Nimodipine Administration Time is Non-UTD value, continue processing and proceed to calculate Timing II.
14. Calculate Timing II (in minute). Timing II (in minute) is equal to the Nimodipine Administration Date and Nimodipine Administration Time minus Arrival Date and Arrival Time, continue processing and proceed to check Timing II.

15. Check Timing II
  1. If Timing II is less than 0 minutes, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Timing II is greater than 1440 minutes, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Timing II is greater than or equal to 0 minutes and less than or equal to 1440 minutes, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Stop processing.

Measure Information Form CSTK-06
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Specifications Manual for Joint Commission National Quality Measures (v2025A)
Discharges 01-01-25 (1Q25) through 06-30-25 (2Q25)

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