Home
Referring Site
47.2%of patients transferred to an EVT centre for EVT received EVT
EQUITY
3.8%of Ischemic Stroke patients received EVT
EVT CentreONTARIO*
CTA, CTP orMRA
IVTPA
Arterial Puncture
EVT Procedure
Reperfusion Achieved
Critical Step-down Unit
EVT Centre Stroke Unit
TIMELINESSMedian time from ED
arrival (at EVT site)to :
qualifying CTA, CTP or MRA
arterial puncture
time of first reperfusion
EFFECTIVENESS
99.4%of EVT patients received CTA, CTP or MRA prior to the EVT procedure
75.3%of EVT patients were successfully reperfused
47Median number of days EVT patients spent at home in first 90 days post procedure
Next Level ofCare
20.4%30-day all-cause mortality rates for patients who received EVT
17 min
78 min
112.5 min
The EVT Dashboard landing page (Figure 2) provides users with a visual representation of the EVT patient journey:
Users have the option to view either provincial orhospital-specificresults Each indicator is linked to a more detailed pagewhichfocusesononeofthequality domains/questionsandprovidesrelated indicatorresults
The detailed pages (Figure 2) present results graphically and allow for cross-hospital comparison: Whereavailable,targetsareincluded Denominatorandnumeratorvalues,and25th, 75thand50th percentiles are available for each hospital in the province Outcomeindicatorsarestratifiedtoinclude/ excludein-hospitalstrokes
CorHealthOntariotodevelopaprovincialqualityimprovementprocessforEVTthatwillleveragetheseresultsPerformanceofindividualhospitals,basedonkeyperformanceindicators,maybeusedtoinformfuturefundingrecommendationsIntegratetheEVTKPIintootherstrokereportingtoillustratethecompletepictureofstrokecareinOntarioExploretheopportunitytoobtainadditionalinformationfromthereferralhospitalstobetterunderstandpatientoutcomes
RegionalStrokeCentre&EVTCentre (9)
RegionalStrokeCentre&Telestroke (2)
DistrictStrokeCentre&EVTCentre (1)
DistrictStrokeCentre (2)
DistrictStrokeCentre&Telestroke (14)
Telestroke (13)
OntarioLHIN (14)
EVT INDICATOR SELECTIONThetaskgroupidentified22indicatorsandprioritizedtheseforreportingbasedonthefollowingconsiderations:
Level of Reporting:patientoutcomes,access,systemperformanceandkeyprocesses Data Availability: abilitytocalculatetheindicatorusingexistingdatasources Redundancy: whethertheindicatoriscapturedinotherprovincialreports Distribution of Indicators: wheretheindicatorfitsinthepatientjourney–preEVT,duringEVTandpostEVT Quality Domain: capturesvariousaspectsofqualityincludingtimeliness,equity,andeffectiveness
Ofthe22proposedindicators,12couldbecalculatedusingexistingdataheldbytheCanadianInstituteforHealthInformation(CIHI).Afterfactoringinthelevelofreporting,redundancy,distributionandqualityoftheseindicators,3wereexcluded,resultinginatotalof9keyperformanceindicators.
DEFINING THE COHORT AND DEVELOPMENT OF TECHNICAL SPECIFICIATIONS IterativelydevelopedbyCorHealthOntario’sanalyticsteamincollaborationwiththeEVTPMMGroup ICES,asanindependentandexperiencedentityinhealthservicesresearch,reviewedindicatortechnicalspecificationsandprovided recommendationsforfurtherrefinement CorHealthOntario’sanalyticsteamcalculatedallindicatorsandvettedresultsthroughtheRegionalStrokeProgramManagers/Directorsatthe EVThospitalstoensurealignmentbetweenresultsandindividualtracking/clinicalexperience
DEVELOPMENT OF A REPORTING TOOL Internalblue-skythinkingsessiontodevelopavisionforthereport Keytakeaways:reportshould“tellastory” “Thestory”istoldthroughfourquestions(Table1) Eachindicatorisalignedwithaquestion Mock-upofdashboardcreated,andfeedbackobtainedfromkeystakeholder(e.g.RegionalStrokeProgramManagers/Directors) IntegratedDecisionSupport(IDS),atechnologyinfrastructurehostedanddeliveredbyHamiltonHealthSciences,createdandimplementedaninteractive dashboardofindicatorresultsandmadeitavailabletoallEVTsites(Figure2)
Developing and Implementing Key Performance Indicators (KPI) for Endovascular Thrombectomy in OntarioAuthors: Kathryn Yearwood, Dr. Richard H. Swartz, Anar Pardhan, Phongsack Manivong, Julie Tang, Leah Justason, Shelley A. Sharp, Dr. Mark Bayley, Dr. Leanne K. Casaubon, Kathy Godfrey, Dr. Moira K. Kapral, Elizabeth Linkewich, Rhonda McNicoll-Whiteman, Joan Porter, Dr. Grant Stotts, Dr. Amy Y. X. Yu, Mirna Rahal
Background
2. REPORTING TOOL: EVT DASHBOARDConclusionThekeyperformanceindicators(KPIs)andreportingprocessmarkacriticalmilestoneinpromotingsuccessfulimplementationofEVTinOntario.Theseindica-torsareintendedtodrivequalitypracticeimprovementandinformsystemplanningatinstitutionandpopulationlevels.
IntegratedDecisionSupport(IDS)LindsayArscottandLindsaySiurna,DataQuality,CorHealthOntarioRichelleHimaya,Design,CorHealthOntarioICES
PROVINCIAL QUALITY IMPROVEMENT
AccesstoEVTvariesconsiderablybetweenpatientspresentingdirectlytoanEVThospitalandthosewhofirstpresenttoahospitalthatonlyprovidesthrombolysis(i.e.tissueplasminogenactivator(tPA))forstroke.Assuch,theEVTSteeringCommitteehasrequestedtheEMS/PatientTransportTaskGrouptodeveloprecommendationsregardingtheuseoflargevesselocclusion(LVO)screeningtoolswithEmergencyMedicalServiceProviderstostreamlineaccesstoEVThospitalsforthosepatientslikelytobeeligibleforEVT.
LOCAL QUALITY IMPROVEMENT
InSeptember2019,biannualandannualtrendingwillbeincludedforeachindicatortoenableindividualhospitalstotracktheirprogressovertime.
3. QUALITY IMPROVEMENT
TIMELINESS: Are patients being identified and treated in a timely manner?
EQUITY: Do patients have equitable access to EVT throughout the province?
EFFECTIVENESS: Are the appropriate patients being identified, referred, and accepted for EVT?
EFFECTIVENESS: Are the desired outcomes being achieved?
QUALITY DOMAINS/QUESTIONS
Mediantimefromemergencydepartment(ED)arrival(atEVTsite)toqualifyingcomputedtomographyangiograph(CTA),computedtomographyperfusion(CTP),magneticresonanceangiography (MRA)
MediantimefromEDarrival(atEVTsite)toarterialpuncture
MediantimefromEDarrival(atEVTsite)totimeoffirstreperfusion
ProportionandnumberofischemicstrokepatientswhoreceiveanEVTprocedure(cross-regionalcomparisonindetailedpages)
ProportionofpatientstransferredtoanEVTcentreforEVTwhoreceivedEVTprocedurebyLHINand/orfacility
30-dayrisk-adjustedall-causemortalityratesforpatientswhoreceivedEVT
MediannumberofdaysEVTpatientsspendathomeinthefirst90dayspostprocedure
ProportionofEVTpatientssuccessfullyreperfused
INDICATORS
Results
Methods
InOntario,EndovascularThrombectomy(EVT)isperformedat10specializedhospitalsacrosstheprovince(Figure1).In2017,theMinistryofHealthandLong-TermCare(MOHLTC)requestedthatCorHealthOntario1 establish a framework for measuring,monitoringandreportingonEVTperformancetoensurealignmentwithbestpractices,improvesystemplanninganddrivequality/systemimprovements.Tosupportthedevelopmentofthisframework CorHealth Ontario leveraged theexpertiseoftheprovincialEVTPerformanceMeasurementandMonitoring(EVTPMM)TaskGroup.ThisgroupreportstoCorHealthOntario’sEVTSteeringCommitteeaspartofCorHealthOntario’sexternalgovernancestructureandconsistsofagroupofcontentexperts,includingneurologists,clinicalnursespecialists,epidemiologistsandotherkeystakeholderswithexpertiseinstrokesystemevaluationandimplementation.
Figure 1. MapofhospitalsinOntariothatofferhyperacutestrokecare.
Figure 2. EVTDashboardlandingpageindicatingtheabilitytoclickonspecificsectionsformore detailedpages,includinghospitallevelresults.
1. QUALITY DOMAINS/QUESTIONS AND KEY PERFORMANCE INDICATORS
TIMELINESS
1. CorHealthOntarioisacentralagencythatadvisestheMinistryofHealthandLong-TermCare(publicfunder),hospitals,andcareproviderstoimprovethe quality,efficiency,accessibilityandequityofcardiac,strokeandvascularservicesforpatientsacrossOntario.
Table 1. Qualitydomains/questionsandkeyperformanceindicators
CorHealthOntariodevelopedadataquality(DQ)managementmodel,theDQandComplianceProgram,toensuredataisofhigh-qualityandfit-for-use,withafocusonimprovingdataatthesource.
TheDQandComplianceProgramwasappliedtoEVTdataandconsistsofthefollowing:
9EVTDQindicatorswhichwereidentifiedandvalidatedbytheEVTPMMTaskGroup Areportshowingtheindicatorscomparedagainstthresholds/acceptablevalues Aquarterlyprocessforreviewandfeedback
Hospitalsusethereporttoinvestigate,correctissues,providefeedbacktoCorHealthOntario,andputinplacedataimprovementplanstoresolveissuesandhelppreventthemfromreoccurring.
TheDQandComplianceProgramhasincreasedthequalityoftheEVTdata.Withthisincreasedqualitycomesincreasedconfidenceinreportingandtheabil-itytocreateaccurateactionplans,allwiththegoalofimprovingEVTservicesinOntario.
4. DATA QUALITY (DQ)
EQUITY EFFECTIVENESS EFFECTIVENESS
STROKE SITE CATEGORY
Next Steps
AcknowledgementsCorHealthOntariowouldliketoextendtheirgratitudetothefollowingfortheirinvolvementinthisproject:
Stroke EVT DashboardOverview Page
Facility: ONTARIO* Fiscal Year: FY 17/18 Fiscal Quarters: Q1, Q2, Q3, Q4
References
