Specifications Manual for Joint Commission National Quality Measures (v2027A)
Posted: 8/7/2026

Release Notes:
Measure Information Form
Version 2027A

Measure Information Form

Measure Set: Stroke (STK)

Set Measure ID: STK-8

Performance Measure Name: Stroke Education

Description: Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke.

Rationale: There are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (e.g., cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient’s prognosis and potential for rehabilitation.

Stroke education starts with information about key warning signs and symptoms, as well as, steps to activate the emergency medical system (EMS) if and when stroke signs and symptoms occur. Early recognition can decrease arrival times to the emergency department, hasten stroke diagnosis, increase treatment times for patients eligible for reperfusion therapies, and ultimately improve outcomes for more patients, (Prabhakaran, S., et al., 2026). Education can be reinforced during an inpatient admission for an acute stroke event but should begin sooner to improve stroke knowledge and awareness across a population and potentially prevent first-time strokes.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Ischemic or hemorrhagic stroke patients with documentation that they or their caregivers were given educational material addressing all of the following:
1. Activation of emergency medical system
2. Follow-up after discharge
3. Medications prescribed at discharge
4. Risk factors for stroke
5. Warning signs and symptoms of stroke

Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Ischemic stroke or hemorrhagic stroke patients discharged home.
Included Populations:
  • Discharges with an ICD-10-CM Principal Diagnosis Code for ischemic or hemorrhagic stroke as defined in Appendix A, Table 8.1 or Table 8.2.
AND
  • A discharge to home, home care or court/law enforcement

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

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. 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:
  • Greenberg, S. M., Ziai, W. C., Cordonnier, C., Dowlatshahi, D., Francis, B., Goldstein, J. N., Hemphill, J. C., III, Johnson, R., Keigher, K. M., Mack, W. J., Mocco, J., Newton, E. J., Ruff, I. M., Sansing, L. H., Schulman, S., Selim, M. H., Sheth, K. N., Sprigg, N., & Sunnerhagen, K. S. (2022). 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke, 53 (7), e325–e326.
  • Hoh, B. L., Ko, N. U., Amin-Hanjani, S., Chou, S. H.-Y., Cruz-Flores, S., Dangayach, N. S., Derdeyn, C. P., Du, R., Hänggi, D., Hetts, S. W., Ifejika, N. L., Johnson, R., Keigher, K. M., Leslie-Mazwi, T. M., Lucke-Wold, B., Rabinstein, A. A., Robicsek, S. A., Stapleton, C. J., Suarez, J. I., … Welch, B. G. (2023). 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke, 54, e321. https://doi.org/10.1161/STR.000000000000043.
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al., on behalf of the American Heart Association Stroke Council. (2018). 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, 49, e10–e11, e26–e30.
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke—A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50 (12), e344–e418.
  • Prabhakaran, S., Gonzalez, N. R., Zachrison, K. S., Adeoye, O., Alexandrov, A. W., Ansari, S. A., Chapman, S., Czap, A. L., Dumitrascu, O. M., Ishida, K., Jadhav, A. P., Johnson, B., Johnston, K. C., Khatri, P., Kimberly, W. T., Lee, V. H., Leslie-Mazwi, T. M., Mac Grory, B., Madsen, T. E., Menon, B., Mistry, E. A., Park, S., Parker, S., Pérez de la Ossa, N., Reeves, M., Saiz, T., Scott, P. A., Schwartzberg, D., Sheth, S. A., Sporns, P. B., Times, S., Tjoumakaris, S., Wolfe, S. Q., & Yaghi, S.; Peer Review Committee Collaborators. (2026). 2026 guideline for the early management of patients with acute ischemic stroke: A guideline from the American Heart Association/American Stroke Association. Stroke. Advance online publication. https://doi.org/10.1161/STR.0000000000000513.

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.

STK-8: Algorithm Narrative

STK-8: Stroke Education

Numerator: Ischemic or hemorrhagic stroke patients with documentation that they or their caregivers were given educational material addressing all of the following: 1. Activation of emergency medical system 2. Follow-up after discharge 3. Medications prescribed at discharge 4. Risk factors for stroke 5. Warning signs and symptoms of stroke.
Denominator: Ischemic stroke or hemorrhagic stroke patients discharged home.

Variable Key Missing Counter, Education Counter

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

2. Check Discharge Disposition.
  1. If Discharge Disposition is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Discharge Disposition equals 2, 3, 4, 5, 6 or 7 the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Discharge Disposition equals 1, or 8 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, 2 or 3 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 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 check Elective Carotid Intervention.

5. Check Elective Carotid Interventions.
  1. If Elective Carotid Intervention is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Elective Carotid Intervention 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 Elective Carotid Intervention equals N continue processing and proceed to Initialize Counter.

6. Initialize Missing Counter and Education Counter. Set both counters equal to zero. Continue processing and proceed to check Education Addresses Activation of Emergency Medical System.

7. Check Education Addresses Activation of Emergency Medical System.
  1. If Education Addresses Activation of Emergency Medical System is missing, add 1 to Missing Counter, continue processing and proceed to check Education Addresses Follow-up After Discharge.
  2. If Education Addresses Activation of Emergency Medical System equals Y, add 1 to Education Counter, continue processing and proceed to check Education Addresses Follow-up After Discharge.
  3. If Education Addresses Activation of Emergency Medical System equals N, continue processing and proceed to check Education Addresses Follow-up After Discharge.

8. Check Education Addresses Follow-up After Discharge.
  1. If Education Addresses Follow-up After Discharge is missing, add 1 to Missing Counter, continue processing and proceed to check Education Addresses Medications Prescribed At Discharge.
  2. If Education Addresses Follow-up After Discharge equals Y, add 1 to Education Counter, continue processing and proceed to check Education Addresses Medications Prescribed At Discharge.
  3. If Education Addresses Follow-up After Discharge equals N, continue processing and proceed to check Education Addresses Medications Prescribed At Discharge.

9. Check Education Addresses Medications Prescribed At Discharge.
  1. If Education Addresses Medications Prescribed At Discharge is missing, add 1 to Missing Counter, continue processing and proceed to check Education Addresses Risk Factors for Stroke.
  2. If Education Addresses Medications Prescribed At Discharge equals Y, add 1 to Education Counter, continue processing and proceed to check Education Addresses Risk Factors for Stroke.
  3. If Education Addresses Medications Prescribed At Discharge equals N, continue processing and proceed to check Education Addresses Risk Factors for Stroke.

10. Check Education Addresses Risk Factors for Stroke.
  1. If Education Addresses Risk Factors for Stroke is missing, add 1 to Missing Counter, continue processing and proceed to check Education Addresses Warning Signs and Symptoms of Stroke.
  2. If Education Addresses Risk Factors for Stroke equals Y, add 1 to Education Counter, continue processing and proceed to check Education Addresses Warning Signs and Symptoms of Stroke.
  3. If Education Addresses Risk Factors for Stroke equals N, continue processing and proceed to check Education Addresses Warning Signs and Symptoms of Stroke.

11. Check Education Addresses Warning Signs and Symptoms of Stroke.
  1. If Education Addresses Warning Signs and Symptoms of Stroke is missing, add 1 to Missing Counter, continue processing and proceed to check Missing Counter.
  2. If Education Addresses Warning Signs and Symptoms of Stroke equals Y, add 1 to Education Counter, continue processing and proceed to check Missing Counter.
  3. If Education Addresses Warning Signs and Symptoms of Stroke equals N, continue processing and proceed to check Missing Counter.

12. Check Missing Counter.
  1. If Missing Counter is greater than 0, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Missing Counter equals 0, continue processing and proceed to check Education Counter.

13. Check Education Counter.
  1. If Education Counter is less than 5, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  2. If Education Counter equals 5, the case will proceed to a Measure Category Assignment of E and will be in the numerator population, Stop processing.

Measure Information Form STK-8
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Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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