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Evaluating the Effectiveness of Concurrent Review: Does It Improve Stroke Measure Results?

McGillivray, Celia Gomes ACNPC-AG, MSN, BC-RN, MPH, CHES; Silver, Brian MD

Quality Management in Healthcare: April/June 2017 - Volume 26 - Issue 2 - p 97–102
doi: 10.1097/QMH.0000000000000130
Quality Improvement Initiatives

Background: Concurrent review is a quality improvement strategy in which patients are tracked from admission to discharge, and messages are communicated to the responsible physician when quality stroke measures have not been met. There is little research regarding interventions that might influence clinical practice patterns and improvement in compliance with core quality measures. This study sought to evaluate whether concurrent review implementation was associated with change in performance on stroke measure outcome data.

Methods: Randomly selected charts from 2 hospitals (A and B) during 3 time periods were reviewed. In period 1, neither hospital had a process for concurrent review. In period 2, hospital A, where concurrent review was implemented, was compared with hospital B without this process. In period 3, both hospitals had the process of concurrent review. Information on baseline demographics, insurance status, and length of stay was collected, as well as stroke performance measures.

Results: A total of 620 medical records were reviewed during the 3 time periods. Although the number of beds and annual stroke volume were higher at hospital B, patient characteristics were similar. During period 2, when hospital A implemented concurrent review and hospital B had not, a statistically significant higher compliance with performance in 7 stroke measures occurred in hospital A than in hospital B. In period 3, when both hospitals utilized concurrent review, no statistical significant differences occurred in 7 of the 10 stroke measures.

Conclusion: Concurrent review is a quality improvement intervention that increases performance with stroke performance measures.

Desert Regional Medical Center, Institute of Clinical Orthopedic and Neurosciences, Palm Springs, California (Ms McGillivray); and Department of Neurology, Rhode Island Hospital, Providence, Rhode Island (Dr Silver).

Correspondence: Celia Gomes McGillivray, ACNPC-AG, MSN, BC-RN, MPH, CHES, Desert Regional Medical Center, Institute of Clinical Orthopedic and Neurosciences, PO Box 2285, Palm Springs, CA 92263 (

The author thanks Cynthia Padula, PhD, RN, Rhode Island College, for guidance, and William Anger, MLIS, The Miriam Hospital, for expertise with literature searches. No one received compensation.

The authors declare no conflict of interest.

© 2017Wolters Kluwer Health | Lippincott Williams & Wilkins