Logo for the Journal of Rehab R and D

Volume 45 Number 7, 2008
   Pages 1027 — 1036

Abstract - Geographic variation in poststroke depression among veterans
with acute stroke

Huanguang Jia, PhD, MPH;1* L. Douglas Ried, PhD;1-2 Xinping Wang, PhD;1 Teresa M. Damush, PhD;3 Linda J. Young, PhD;1 Randi H. Cameon, MPH;1 Linda S. Williams, MD3

1Department of Veterans Affairs (VA) Stroke Quality Enhancement Research Initiative (QUERI) and VA Rehabilitation Outcomes Research Center Research Enhancement Award Program, Gainesville, FL; 2College of Pharmacy, University of Florida, Gainesville, FL; 3VA Stroke QUERI and VA Center on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, and Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, IN

Abstract — This study 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. Logistic regression models were fit to compare VA PSD diagnosis and overall PSD detection between the regions. The use of VA medical data alone may underestimate the rate of PSD. Geographic variation in PSD detection depended on the data 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 in overall PSD detection across the regions after adjusting for potential risk factors. VA clinicians and policy makers need to consider enrollees' use of services outside the system when conducting program evaluation. Future research on PSD among veteran patients should use VA medical data in combination with Medicare and VA pharmacy data to obtain a comprehensive understanding of patients' PSD.

Key words: geographic variation, ICD-9, Medicare, poststroke depression, PSD detection, rehabilitation, stroke, "stroke belt," VA, veterans.

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