UCLA Study Saves Life-Saving Stroke Care From Flawed Metric

Hospitals performing life-saving stroke procedures have been getting punished for helping the patients who need it most, but new research is fixing that problem.

A UCLA study published in the Journal of NeuroInterventional Surgery found that a widely used federal safety metric has been fundamentally misapplied to emergency stroke care. The metric, called Patient Safety Indicator 04, was designed to track preventable deaths after elective surgeries on healthy patients.

The problem? It's been applied to emergency thrombectomy procedures that remove blood clots in stroke patients who arrive at the hospital already critically ill.

Dr. Melissa Marie Reider-Demer and her UCLA team analyzed over 73,000 stroke procedures nationwide between 2016 and 2019. They discovered that 20.5% of stroke thrombectomy patients triggered the safety flag, compared to just 0.10% for most other procedures.

That shocking difference wasn't because hospitals were doing bad work. It was because stroke patients often develop pneumonia, blood clots, and other complications from the stroke itself, not from the procedure that's trying to save their lives.

At UCLA's Comprehensive Stroke Center, researchers reviewed every flagged case between 2016 and 2018. An expert panel found that not a single case represented an actual preventable safety concern. Every death was related to the severity of the patient's stroke, not the quality of care.

"We're essentially penalizing hospitals for trying to save patients who are already dying from stroke," Dr. Reider-Demer explained. "These procedures give severely affected patients their only chance at survival or functional recovery."

The flawed metric created a dangerous situation. Previous research shows that when surgeons worry about their safety ratings, some avoid treating the sickest patients to protect their scores. That means the people who need help most might not get it.

Dr. Jeffrey Saver, the study's senior author and vice chair for Clinical Research at UCLA Health, warned that stroke centers treating high volumes of critically ill patients could be unfairly penalized in quality ratings and reimbursement. That would discourage hospitals from performing procedures on patients with the most severe strokes.

Here's the good news: Medicare listened. The Centers for Medicare & Medicaid Services has proposed revising the metric to exclude patients with acute conditions like stroke coded as their principal reason for admission. The fix is planned for fiscal year 2027.

"This revision makes sense from a clinical perspective," Dr. Saver said. "The current metric doesn't identify preventable events in stroke care."

The change comes at a crucial time. Recent clinical trials have expanded thrombectomy to patients with even larger, more severe strokes. These patients have high mortality rates even with intervention, though their outcomes are still better than without treatment.

Thanks to UCLA's research, hospitals will soon be able to focus on what matters most: saving lives without worrying that doing the right thing will make them look bad on paper.