Introduction: The value of setting performance benchmarks for quality improvement projects remains unclear. The Achievable Benchmarks of Care (ABC™) methodology has been proposed as an objective, reproducible, and data-driven approach, but it has not been widely utilized in stroke registries. We applied the ABC™ methodology to set benchmarks using data from the Coverdell stroke registry.
Methods: Data were from Paul Coverdell National Acute Stroke Program from 2012-2014. Adherence data were calculated on 14 quality measures including tPA related treatment, hospital care, and discharge care. We applied the ABCTM methodology by first ranking hospitals in descending order of performance for each quality measure. We then calculated the pared mean performance associated with patients selected from these hospitals representing the top 10% and 50% of patients.
Results: A total of 170 402 acute ischemic strokes from 465 hospitals in 11 states were included. The Figure shows overall 10% and 50% benchmarks (BM) for the 14 quality measures. BMs were high (>90%) for 12 of the 14 measures. Two measures with lower performance were tPA administered among all ischemic stroke patients, and door to needle (DTN) < 60 minutes. However, both measures improved significantly over time. The 10% BM for tPA administration improved from 28% in 2012 to 30% in 2014, while the 10% BM for DTN within 60 minutes improved from 82% in 2012 to 90% in 2014.
Conclusions: The ABC™ methodology provides an objective method of calculation BMs for care. These data illustrate that BMs are already high for the majority of the quality measures tracked in the registry. Further analyses are ongoing to determine the acceptability of using these BMs to promote further improvements in care across the Coverdell Program.