- Initial Population =
- AND: Age >= 18 year(s) at: Occurrence A of $EncounterInpatientNonElective
- AND: Union of:
- "Diagnosis, Active: Ischemic Stroke (ordinality: Principal)"
- "Diagnosis, Active: Hemorrhagic Stroke (ordinality: Principal)"
- starts during Occurrence A of $EncounterInpatientNonElective
- Denominator =
- AND: "Diagnosis, Active: Ischemic Stroke (ordinality: Principal)" starts during Occurrence A of $EncounterInpatientNonElective
- AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective
- AND: Union of:
- "Physical Exam, Performed: Baseline State" <= 120 minute(s) ends before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- "Physical Exam, Performed: Time of Symptom Onset" <= 120 minute(s) starts before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- Denominator Exclusions =
- Numerator =
- AND: Union of:
- "Medication, Administered: Thrombolytic (t-PA) Therapy" <= 180 minute(s) starts after end of
- "Physical Exam, Performed: Baseline State" <= 120 minute(s) ends before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- "Medication, Administered: Thrombolytic (t-PA) Therapy" <= 180 minute(s) starts after start of
- "Physical Exam, Performed: Time of Symptom Onset" <= 120 minute(s) starts before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- Numerator Exclusions =
- Denominator Exceptions =
- OR: Union of:
- $InterventionComfortMeasures
- $MedicalReasonForNotInitiatingIVThrombolytic
- <= 1 day(s) starts after start of Occurrence A of $EncounterInpatientNonElective
- OR: Union of:
- $InterventionComfortMeasures starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"
- $MedicalReasonForNotInitiatingIVThrombolytic starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"
- OR: Union of:
- "Laboratory Test, Performed: Prothrombin Time (result > 15 second(s))"
- "Laboratory Test, Performed: INR (result > 1.7 )"
- "Laboratory Test, Performed: Platelet Count (result < 100000 )"
- "Laboratory Test, Performed: Partial Thromboplastin Time (result > 40 second(s))"
- "Physical Exam, Performed: Systolic Blood Pressure (result > 185 mmHg)"
- "Physical Exam, Performed: Diastolic Blood Pressure (result > 110 mmHg)"
- "Medication, Order not done: Patient Refusal" for "t-PA ingredient specific"
- "Medication, Administered not done: Patient Refusal" for "Thrombolytic (t-PA) Therapy"
- <= 180 minute(s) starts after end of
- "Physical Exam, Performed: Baseline State" <= 120 minute(s) ends before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- OR: Union of:
- "Laboratory Test, Performed: Prothrombin Time (result > 15 second(s))"
- "Laboratory Test, Performed: INR (result > 1.7 )"
- "Laboratory Test, Performed: Platelet Count (result < 100000 )"
- "Laboratory Test, Performed: Partial Thromboplastin Time (result > 40 second(s))"
- "Physical Exam, Performed: Systolic Blood Pressure (result > 185 mmHg)"
- "Physical Exam, Performed: Diastolic Blood Pressure (result > 110 mmHg)"
- "Medication, Order not done: Patient Refusal" for "t-PA ingredient specific"
- "Medication, Administered not done: Patient Refusal" for "Thrombolytic (t-PA) Therapy"
- <= 180 minute(s) starts after start of
- "Physical Exam, Performed: Time of Symptom Onset" <= 120 minute(s) starts before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- OR: Union of:
- "Medication, Administered: Thrombolytic (t-PA) Therapy"
- "Procedure, Performed: Intravenous Thrombolytic (t-PA) Therapy"
- <= 2 day(s) starts before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
- OR: First: "Occurrence A of Risk Category Assessment: National Institute of Health Stroke Scale (result = 0 )" starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"
- Stratification =
- $EncounterInpatientNonElective =
- "Encounter, Performed: Non-Elective Inpatient Encounter" satisfies all
- (length of stay <= 120 day(s))
- ends during "Measurement Period"
- $InterventionComfortMeasures =
- Union of:
- "Intervention, Order: Comfort Measures"
- "Intervention, Performed: Comfort Measures"
- $MedicalReasonForNotInitiatingIVThrombolytic =
- Union of:
- "Medication, Order not done: Medical Reason" for "t-PA ingredient specific"
- "Medication, Administered not done: Medical Reason" for "Thrombolytic (t-PA) Therapy"
- "Diagnosis, Active: Hemorrhagic Stroke" using "Hemorrhagic Stroke Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.212)"
- "Diagnosis, Active: Ischemic Stroke" using "Ischemic Stroke Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.247)"
- "Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.292)"
- "Encounter, Performed: Non-Elective Inpatient Encounter" using "Non-Elective Inpatient Encounter SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.424)"
- "Intervention, Order: Comfort Measures " using "Comfort Measures SNOMEDCT Value Set (1.3.6.1.4.1.33895.1.3.0.45)"
- "Intervention, Performed: Comfort Measures " using "Comfort Measures SNOMEDCT Value Set (1.3.6.1.4.1.33895.1.3.0.45)"
- "Laboratory Test, Performed: INR" using "INR LOINC Value Set (2.16.840.1.113883.3.117.1.7.1.213)"
- "Laboratory Test, Performed: Partial Thromboplastin Time" using "Partial Thromboplastin Time LOINC Value Set (2.16.840.1.113762.1.4.1045.25)"
- "Laboratory Test, Performed: Platelet Count" using "Platelet Count LOINC Value Set (2.16.840.1.113883.3.117.1.7.1.267)"
- "Laboratory Test, Performed: Prothrombin Time" using "Prothrombin Time LOINC Value Set (2.16.840.1.113762.1.4.1045.24)"
- "Medication, Administered: Thrombolytic (t-PA) Therapy" using "Thrombolytic (t-PA) Therapy RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.226)"
- "Medication, Administered not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
- "Medication, Administered not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
- "Medication, Order: t-PA ingredient specific" using "t-PA ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.6)"
- "Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
- "Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
- "Physical Exam, Performed: Baseline State" using "Baseline State SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.417)"
- "Physical Exam, Performed: Diastolic Blood Pressure" using "Diastolic Blood Pressure LOINC Value Set (2.16.840.1.113883.3.526.2.1045)"
- "Physical Exam, Performed: Systolic Blood Pressure" using "Systolic Blood Pressure LOINC Value Set (2.16.840.1.113883.3.526.2.1044)"
- "Physical Exam, Performed: Time of Symptom Onset" using "Time of Symptom Onset SNOMEDCT Value Set (2.16.840.1.113762.1.4.1045.14)"
- "Procedure, Performed: Intravenous Thrombolytic (t-PA) Therapy" using "Intravenous Thrombolytic (t-PA) Therapy SNOMEDCT Value Set (2.16.840.1.113762.1.4.1045.15)"
- "Risk Category Assessment: National Institute of Health Stroke Scale" using "National Institute of Health Stroke Scale LOINC Value Set (2.16.840.1.113883.3.117.1.7.1.269)"
- Attribute: "Ordinality: Principal" using "Principal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.14)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
- "Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeGender Value Set (2.16.840.1.113762.1.4.1)"