Interactive Checklist, Financial Incentive Improves Stroke Quality Care

The checklist included reminders for time-sensitive measures.

WASHINGTON — An interactive support checklist and financial incentives help improve residents’ compliance with stroke care processes, a new study indicates. The report was presented at the American Academy of Neurology 2015 Annual Meeting.

Researchers from Detroit Medical Center, associated with Wayne State University Medical School, found that empowering residents through leadership roles proved an important step in their integration into the health care system.

Marissa Dean, MD, and colleagues developed a novel, interactive, 10-step electronic medical record checklist to monitor real-time gaps in stroke process measures and implemented a pay-for-performance plan to promote quality improvement across the four hospitals within the Detroit Medical Center health system. The checklist includes measures such as teaching patients about stroke, prescribing statins to all discharged patients, and administering venous thromboembolism (VTE) prophylaxis within 24 hours. Time-sensitive measures on the checklist include a pop-up reminder that the task needs to be completed as soon as possible. In the instance that a provider decides not to administer a medication or other measure on the checklist, proper documentation of the decision will fulfill the checklist.

Led by 14 paid resident quality directors, the interactive checklist was applied to all adult patients across the four hospitals beginning January 1, 2014. The directors monitored daily performance and provided feedback on care gaps to physicians, mid-level providers, and 800 residents.

Six months after the intervention was applied, compliance with stroke process measures was 96.56% (P<0.024), compared to 88% six months prior to the intervention. By December 2014, compliance levels reached 100%. Over 800 residents received incentive payments in June 2014 and November 2014 as a result.

The researchers noted that while no one measure seemed to be neglected more than another, general documentation of such measures is where providers fall short. This lack of communication may cause issues with billing and patient care as patients transition from provider to provider.


  1. Dean M et al. Engaging Residents in Stroke Quality Measures with Financial Incentives and Electronic Checklist. Abstract S11.007. Presented at: American Academy of Neurology Annual Meeting 2015. April 18-25, 2015; Washington, D.C.