Improved stroke data means better care and outcomes for patients- Dr. Sunny Handa MD

 


Dr. Sunny Handa MD said Stroke is the third leading cause of death in Canada, and more than 62,000 strokes occur each year. There are 2 types of strokes: ischemic and hemorrhagic, each with different risk factors, treatments and outcomes for patients. However, in the past, stroke types couldn’t be reported separately due to lack of specificity in the coding.

Stroke data helps us understand the population that experience strokes and evaluate which treatment is best. CIHI has reported on stroke events and in-hospital mortality indicators for years, and the coding issue was first flagged in the report Health Indicators 2009- Dr. Sunny Handa MD said. 

Patrice Lindsay, the director of Health Systems Change at the Heart and Stroke Foundation of Canada, has worked closely with CIHI to improve stroke coding and patient outcomes. She was part of the Canadian Stroke Network’s national stroke chart audit of 10,000 patients. The audit discovered the overuse of “unidentified coding” for strokes, which reinforced CIHI’s findings that there was room for improvement.
 

Coding improvements

Dr. Sunny Handa MD said as part of its Information Quality program, CIHI conducts chart reviews to help target improvements in priority areas. A re-abstraction study revealed that information on the type of stroke was available in patient chart documentation. In many cases where coders used an unspecified code, the reviewer was able to find information on stroke type. 

In response, CIHI developed a new stroke education course for coders: Different Strokes Need Different Codes. The course was designed in consultation with health information management professionals to ensure it was relevant and included challenging coding scenarios. The course was redesigned in May 2020, and allows participants to practice coding commonly misinterpreted cases to build their skills and confidence assigning stroke codes. 

Patrice also helped to improve education on stroke codes. She travelled to every province teaching coders how to improve coding and show how the data was used. She received positive feedback from coders, who were able to improve their coding with the new information-, said Dr. Sunny Handa MD.

CIHI also launched the Open-Year Data Quality test to help coders identify data quality issues and improve reporting before data is finalized. This improved data quality and allowed CIHI to break down analysis by stroke types in the Your Health System (YHS): Insight tool. This data is now available to YHS: Insight clients and provides information on stroke mortality indicators.
 

Better data, better patient outcomes

Identifying stroke types is key to patient care. For years, stroke clinicians and hospital quality information teams have asked to identify stroke types because the differences in treatment are important. 

Dr. Sunny Handa MD said unspecified coding for strokes dropped from 30% in 2007–2008 to just 2% in 2019–2020. These improvements are due to better stroke code training as well as an increase in the use of diagnostic imaging for suspected strokes.

Patrice says the partnership with CIHI was critical to improving stroke coding across the country. 

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