The CSS Information and Evaluation Working Group (see Appendix 1 for a list of members) was established to develop a framework to measure the quality and consistency of stroke care delivery across the continuum. Members of the working group include experts in measurement and evaluation as well as frontline clinicians with additional training in this area.
As part of its mandate, the Information and Evaluation Working Group developed a set of performance measures for each final recommendation, to monitor the impact of implementing the recommendation on the quality of patient care and/or patient outcomes. The working group also developed accompanying Measurement Notes that identify potential data sources, methods to enhance data collection, challenges to data access, and data quality issues.
The performance measures that support the best practice recommendations are based on the CSS core performance measures for stroke established at a CSS performance measurement consensus conference in 2005 and updated in 2010. Along with the core performance measures, additional measures for each recommendation were developed and validated as necessary to address the full scope of the recommendation.
As a supplement to the best practice recommendations, the Information and Evaluation Working Group created the comprehensive Canadian Stroke Strategy Performance Measurement Manual.53It includes all performance measures from the best practice recommendations, and shows detailed definitions and calculation formulas. The CSS Performance Measurement Manual is for those who would like to conduct a more in-depth evaluation of the implementation and outcomes for specific recommendations. It contributes to increased consistency and standardization of measuring stroke care performance across Canada, and allows for cross-group comparisons and the development of validated national benchmarks. Benchmarks are currently available for a limited number of stroke performance measures, and several initiatives are under way nationally and internationally to establish more. The CSS Performance Measurement Manual can be found here.
For every best practice recommendation that is implemented, a system for monitoring and measuring its impact must be in place at the local and regional level. The CSS collaborated with research investigators from the Canadian Stroke Network to developed audit tools and data collection mechanisms that are available nationally to support the collection of vital stroke data. In addition, through a partnership with the Canadian Institute for Health Information, a special project has been created to collect data for five of the core indicators as part of routine abstraction of all emergency department and inpatient charts by the hospital. All organizations are encouraged to take part in this project. Additional information can be found in the CSS Performance Measurement Manual.
As with the implementation of the best practice recommendations themselves, it is not expected that users will be able to collect data for all of the performance measures. Therefore, the most significant measures are highlighted in bold type for easy identification. The remaining measures are provided for those who are able to conduct a more extensive evaluation of stroke practices in their region.