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Geographic variation in poststroke depression among veterans with acute stroke

Huanguang Jia, PhD, MPH, et al

In this study, we examined and compared patterns of poststroke depression (PSD) detection among veterans with acute stroke in eight U.S. geographic regions. Department of Veterans Affairs (VA) medical and pharmacy data as well as Medicare data were used. International Classification of Diseases-9th Revision depression codes and antidepressant medication dispensing were applied to define patients' PSD status 12 months poststroke. Geographic variation in PSD detection 12 months poststroke depended on what data were used; if VA medical data alone were used, we found no significant variation; if VA medical data were used along with Medicare and VA pharmacy data, we observed a significant variation after adjusting patient demographic and clinical variables. These findings suggest that VA clinicians need to understand their stroke patients' PSD that is diagnosed outside the VA system to improve care quality and functional recovery of their patients poststroke. They also suggest that VA policy makers need to consider the use of services outside the system by enrollees with stroke when conducting program evaluation and that future research on PSD among veteran patients should use the VA medical data in combination with Medicare and VA pharmacy data to obtain a comprehensive understanding of patients' PSD.

Volume 45 Number 7, 2008
   Pages 1027 — 1036

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