• Jinyi Zhu, Hooman Kamel, Ajay Gupta, Alvin I Mushlin, Nicolas A Menzies, Thomas A Gaziano, Meredith B Rosenthal, and Ankur Pandya.
• Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (J.Z.).
• Ann. Intern. Med. 2023 May 1; 176 (5): 649657649-657.

BackgroundThe American Heart Association and American Stroke Association (AHA/ASA) endorsed 15 process measures for acute ischemic stroke (AIS) to improve the quality of care. Identifying the highest-value measures could reduce the administrative burden of quality measure adoption while retaining much of the value of quality improvement.ObjectiveTo prioritize AHA/ASA-endorsed quality measures for AIS on the basis of health impact and cost-effectiveness.DesignIndividual-based stroke simulation model.Data SourcesPublished literature.Target PopulationU.S. patients with incident AIS.Time HorizonLifetime.PerspectiveHealth care sector.InterventionCurrent versus complete (100%) implementation at the population level of quality measures endorsed by the AHA/ASA with sufficient clinical evidence (10 of 15).Outcome MeasuresLife-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and incremental net health benefits.Results Of Base Case AnalysisDiscounted life-years gained from complete implementation would range from 472 (tobacco use counseling) to 34 688 (early carotid imaging) for an annual AIS patient cohort. All AIS quality measures were cost-saving or highly cost-effective by AHA standards (<$50 000 per QALY for high-value care). Early carotid imaging and intravenous tissue plasminogen activator contributed the largest fraction of the total potential value of quality improvement (measured as incremental net health benefit), accounting for 72% of the total value. The top 5 quality measures accounted for 92% of the total potential value.Results Of Sensitivity AnalysisA web-based user interface allows for context-specific sensitivity and scenario analyses.LimitationCorrelations between quality measures were not incorporated.ConclusionSubstantial variation exists in the potential net benefit of quality improvement across AIS quality measures. Benefits were highly concentrated among 5 of 10 measures assessed. Our results can help providers and payers set priorities for quality improvement efforts and value-based payments in AIS care.Primary Funding SourceNational Institute of Neurological Disorders and Stroke.

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