Background: Intracerebral hemorrhage (ICH) accounts for 10% of strokes and is the most fatal subtype. Unlike ischemic stroke, adoption of quality metrics for ICH has lagged. The 90-day modified Rankin Score (mRS) measures functional outcomes, but its use in ICH patients is rarely reported or tracked as a hospital outcome measure. Objective: The American Heart Association (AHA) partnered with twenty-two Comprehensive Stroke Centers in a three-year initiative to improve ICH data collection and identify barriers to capturing 90-day mRS. The goal was to establish standardized strategies and unified messaging to increase hospital adoption and emphasize the value of tracking post-acute outcomes, facilitate quality improvement, and promote adoption of guideline-directed care. Methods: A survey assessed barriers, motivators, and perceived importance of 90-day mRS collection. Standardized justification tools were created, including a slide deck, SMART goal framework, and shared resources such as telephone scripts, triage algorithms, and EHR optimizations. Get With The Guidelines®-Stroke registry demonstrations highlighted strategies for efficient workflow integration. Results: Survey responses identified barriers including exclusion of ICH patients from workflows, ischemic-focused certification standards, staffing shortages, and limited awareness of research gaps. Respondents emphasized the importance of data capture as essential for outcome comparisons, evidence-based stroke care, and evaluation of acute ICH management. Implementing justification toolkits provides a foundation for hospital adoption of 90-day mRS capture, with opportunities to amplify this work nationally.
Abelt et al. (Thu,) studied this question.