2019 Stroke Center Quality and Outcomes Report

Stroke Quality Report

Dartmouth-Hitchcock Medical Center strives to provide the highest quality stroke care using national standard performance measures. This report shows how Dartmouth-Hitchcock ranks in stroke care compared to all NH hospitals and all New England Medical Centers.

The national benchmark goal is ≥ 85%

Performance Measure	DHMC	New England Medical Centers
Discharged on Anti-thrombotic therapy Percent of patients discharged on a blood thinner to prevent another ischemic stroke.	98.5%	96.5%
Anti-coagulation for atrial fibrillation/flutter Percent of patients treated with a blood thinner at discharge when they have an abnormal heart rhythm that  could cause blood clots.	98.7%	97.7%
Thrombolytic Therapy Percent of patients who arrive to the hospital within 2 hours of stroke symptoms and treated with a clot busting medication within 3 hours of symptom onset.	94.7%	89.1%
Anti-thrombotics by hospital day #2 Percent of patients treated with a blood thinner within Two days  after admission to prevent further Ischemic strokes.	95.7%	94%
Discharged on a Statin Medication Percent of patients treated with a cholesterol-lowering drug to reduce ischemic stroke risk.	98.6%	94.9%
Stroke Education* Percent of patients provided Stroke specific education (i.e. Signs/symptoms, risk factors, how to call 911…) throughout their hospitalization.	83.7%	90.2%
Assessed for Rehabilitation Percent of patients who have been evaluated by a member of the rehabilitation team to assess needs for recovery therapy.	97.9%	96.6%

This information is based on data retrieved from Outcomes Science Get With the Guidelines® data.

*The stroke program at DHMC is actively working on quality improvements in Stroke education provided to patients and families.

Stroke Outcomes Report

Dartmouth-Hitchcock's Stroke program monitors outcomes for all ischemic stroke patients who have emergent neuro-interventions.

In 2019 DHMC performed 78 emergent thrombectomy procedures.  This procedure attempts to remove the clot from a major blood vessel in the brain.

Performance Measure	DHMC	New England Medical Centers
TICI reperfusion grade of 2B or higher Percent of Ischemic stroke patients who had meaningful improvement of blood flow to their brain after undergoing a mechanical embolectomy (a surgical procedure to remove the blood clot from the brain).	81%	85%
Hemorrhagic transformation after IV Alteplase Percent of Ischemic stroke patients who develop significant bleeding in the brain within 36 hours after receiving a clot-busting medication. The lower the percentage, the better	3.1%	2.8%
Hemorrhagic transformation after IA (intra-arterial) Alteplase (tPA) or Thrombectomy Percent of Ischemic stroke patients who develop significant bleeding in the brain within 36 hours after undergoing a surgical procedure to remove a blood clot from the brain. The lower the percentage, the better	5.1%	7.2%
Arrival to skin puncture (procedure start) Median time from hospital arrival to the time of skin puncture to access the artery for a thrombectomy procedure. Goals:   60 min if coming from an outside hospital (OSH);  90 minutes if coming from scene to DHMC	OSH to DH: 49 min (Range: 15-151 min) Direct to DH: 100 min (Range: 66->180 min) All Cases: 72 min	OSH To all New England Hospitals: 51 min (Range: 0->180 min) Direct to All New England Hospitals:  93 min  (Range: 11->180 min) All Cases: 74 min

This information is based on data retrieved from Outcomes Science Get With the Guidelines® data.

*Thrombolysis in cerebral infarction (TICI) scale is a score used to grade brain tissue revascularization.