The ACC submitted Measure #3024: Carotid Endarterectomy (CEA); Evaluation of Vital Status and NIH Stroke Scale at Follow-Up to the National Quality Forum (NQF) during the Consensus Development Process (CDP). Although this is a strong measure, it did not proceed beyond the deliberation stage by the Surgical Project Phase III Standing Committee due to insufficient evidence. The Standing Committee was concerned during the discussion of Measure #3024 that it was a process measure and the evidence provided was insufficient to move forward to the next step in the CDP.

The NQF Open Comment period concludes on Oct. 21 at 6 p.m. Eastern. The ACC asks for assistance in commenting on the NQF website at http://www.qualityforum.org/Surgery_2015-2017.aspx before Oct. 21. Individuals wishing to comment will be asked to create a free account. There is a 3,000 character limit for submissions.

Talking Points:

  • I am submitting comments as an individual physician or organization. I would like to support Measure #3024, Carotid Endarterectomy; Evaluation of Vital Status and NIH Stroke Scale at Follow-Up.
  • Process measures still have value in healthcare quality and may lead to an outcome measure. We must start somewhere.
  • I believe this measure would be beneficial to all CEA patients, as it would require hospitals to perform the NIH Stroke Scale (NSS) at several stages in the care of CEA patients. The NSS would be administered prior to the procedure, prior to discharge and at the 30 day follow-up visit.
    • Early identification of stroke allows timely access to rehabilitation interventions and resources that could lead to better long term outcomes.
    • Assessing vital status and stroke status at 30 days will encourage hospitals to follow the outcomes of this patient population.
    • Hospitals could participate in the NCDR Peripheral Vascular Intervention (PVI) Registry to gather this important data for quality improvement initiatives.
      • Hospitals would receive weekly outcome reports on a dashboard.
      • National benchmarking and comparison to “like” hospitals are provided every quarter by NCDR.
  • Harmonization of related measures is an NQF goal.
    • In February 2016, the NQF's Cardiovascular Phase 3 Standing Committee endorsed companion Measure #2396: Carotid Artery Stenting (CAS): Evaluation of Vital Status and NIH Stroke Scale at Follow-Up.
    • The CAS and CEA patient populations should have the same pre-operative, before discharge and follow-up stroke assessments at 30 days.
  • NIH Stroke Scale is a universally accepted and validated tool. See the NIH Stroke Scale tool [PDF].
    • Inter-rater reliability:
      • The NIH Stroke Scale provides a common language and method of assessment.
      • Every health care provider who earns certification receives identical training across the Nation.
  • A healthcare provider must become certified to administer the NIH Stroke Scale.
    • The NIH Stroke Scale is a critical component of acute stroke assessment. The American Stroke Association, in conjunction with the American Academy of Neurology and the National Institute of Neurological Disorders and Stroke, has developed this CME/CE certified, online training program for healthcare professionals to learn or review how to administer the NIH Stroke Scale for acute stroke assessment.
    • Affordable and accessible online at several sites.
    • Easy and quick to administer.
    • You don't have to be a doctor to become certified. Any licensed health care provider can become certified. The target audience for NIH Stroke certification is physicians, nurses, nurse practitioners, clinical researchers and medical students.

Comments in support of the CEA measure are critical to it being reconsidered. We strongly encourage members of the health care community to comment before the Friday, Oct. 21 at 6 p.m. Eastern deadline. Comments not in support of the measure may have a negative impact on the measure. Note: There is a 3,000 character limit for comments on NQF's website.

Please contact Elizabeth Quinn at the ACC at (202)375-6617 or equinn@acc.org if you have questions or need assistance.