Abstract TP329: True Failures Versus Ambiguous Documentation in Core Measures Noncompliance

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Introduction: Stroke Core Measures are intended to ensure that patients receive high quality, guideline-concordant acute stroke care. Compliance data is collected and reported to the public and to regulatory agencies for benchmarking and for reimbursement.

Hypothesis: Core Measures noncompliance within one academic institution will often reflect ambiguous or incomplete documentation instead of true failure to provide medically appropriate care.

Methods: We retrospectively reviewed Core Measures data for all ischemic and hemorrhagic stroke patients discharged from the University of Michigan between January 2013 and May 2014. Core Measures data was collected and reported per routine practice and contemporaneously reviewed by the institutional team. For this study, Core Measures failures were cross-referenced with the full medical chart and classified as “true failures” when care was not compliant with the Core Measure standard or “documentation failures” when chart review revealed poor documentation of otherwise appropriate care--for example, where a normal neurological examination was not explicitly linked with a decision to defer assessment for rehabilitation. Determinations of the basis for noncompliance on chart review were made by two different reviewers, with 100% agreement.

Results: A total of 40 failures in 872 patients were identified and reviewed. Core Measures failures were documentation failures in 20 patients. Additional details are provided in Table 1.

Conclusion: The high number of documentation-based failures in our experience illustrates potential problems in the use of administratively-defined measures as a marker of the quality of clinical care.

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