Aligning with Standards and Guidelines
Leading up to the Joint Commission mandate for utilization of a stroke registry, various guidelines were published, some reflecting multi-society collaboration, to emphasize the growing understanding that, ultimately, data is key to improving delivery of stroke care and potentially, patient outcomes. See below for a brief description of key papers:
Performance and Training Standards for Endovascular Ischemic Stroke Treatment published in 2009 by a coalition of medical societies to include the American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Cerebrovascular Section, Society of NeuroInterventional Surgery and the Society of Vascular & Interventional Neurology. These standards mandate the tracking of procedural and clinical outcomes for all patients treated with endovascular techniques.
Training Guidelines for Intra-Arterial Catheter-Directed Treatment of Acute Ischemic Stroke published in 2009 by the Society of Interventional Radiology. These Guidelines state that an interventional stroke therapy outcomes registry is necessary to monitor ongoing processes as well as procedural results and clinical outcomes.
Metrics for measuring Quality of Care in Comprehensive Stroke Centers published in 2011 by the American Stroke Association. These metrics recommend the use of a national database or registry to collect data, rather than a local database, in order to avoid redundant efforts that would occur if comprehensive stroke centers designed their own database.
The international Multi-Society Consensus Quality Improvement Guidelines for Intra-Arterial Catheter Directed Treatment of Acute Ischemic Stroke was written by eight international medical societies directly involved in endovascular stroke therapy. These guidelines are the first to specifically mandate benchmarks for individual physician performance, as well as to specify metrics for the major institutional processes that would influence physician performance and patient outcomes. This paper states that “100 percent of patients have the required processes and outcomes data entered into a national database, trial, or registry.”
The Guidelines for the Early Management of Patients with Acute Ischemic Stroke, authored by the American Stroke Association in March 2013 represents the most exhaustive standards for all aspects of emergency stroke care.
Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke published in 2013 by a multispecialty workgroup from STIR (Stroke Imaging Repository) with endorsement by the American Academy of Neurology/Stroke System Work Group, American Association of Neurological Surgeon/Congress of Neurological Surgeon Cerebrovascular Section, American Society of Neuroradiology, Society of Neurointerventional Surgery, and Society of Vascular and Interventional Neurology. These standards mandate the tracking of specific process details for all patients treated with endovascular techniques.
INSTOR is the only stroke registry that fulfills the requirements of the following entities:
- American Stroke Association
- Brain Attack Coalition
- Society of Vascular and Interventional Neurology
- Society of NeuroInterventional Surgery
- American Society of Neuroradiology
- Canadian Interventional Radiology Association
- Cardiovascular and Interventional Radiology Society of Europe
- Society of Cardiac Angiography and Interventions
- Society of Interventional Radiology
- European Society of Minimally Invasive Neurological Therapy