Journal of Rehabilitation Research & Development (JRRD)

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Volume 50 Number 2, 2013
   Pages 263 — 272

Abstract — Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients?

Neale R. Chumbler, PhD;1–4* Huanguang Jia;5 Michael S. Phipps, MD;6–7 Xinli Li, PhD;1 Diana Ordin, MD, MPH;8 Linda S. Williams, MD;1,3–4,9 Laura J. Myers, PhD;1,3,10 Dawn M. Bravata, MD1,3–4,10

1Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN; 2Department of Sociology, Indiana University School of Liberal Arts, Indiana University Purdue University Indianapolis, Indianapolis, IN; 3VA HSR&D Stroke Quality Enhancement Research Initiative Program, Indianapolis, IN; 4Regenstrief Institute, Indianapolis, IN; 5VA HSR&D/Rehabilitation Research and Development Rehabilitation Outcomes Research Center Research Enhancement Award Program, Gainesville, FL; 6Department of Neurology, Yale University School of Medicine, New Haven, CT; 7VA Connecticut Healthcare System, West Haven, CT; 8VA Office of Quality and Performance, Washington, DC; Departments of 9Neurology, and 10Internal Medicine, Indiana University School of Medicine, Indianapolis, IN

Abstract — This study examined whether age disparities existed across postdischarge quality indicators (QIs) for veterans with ischemic stroke who received care at Department of Veterans Affairs medical centers (VAMCs). This retrospective cohort included a national sample of 3,196 veterans who were diagnosed with ischemic stroke and received acute and postdischarge stroke care at 127 VAMCs in fiscal year 2007 (10/1/06 through 9/30/07). Data included an assessment of postdischarge stroke QIs in the outpatient setting during the 6 mo postdischarge. The QIs included measurement of and goal achievement for (1) blood pressure, (2) serum international normalized ratio (INR) for all patients discharged on warfarin, (3) cholesterol (low-density lipoprotein [LDL]) levels, (4) serum glycosylated hemoglobin, and (5) depression treatment. The mean age for the 3,196 veterans included in this study was 67.2 +/– 11.3 yr. Before risk adjustment, there were age differences in (1) depression screening/treatment, (2) blood pressure goals, and (3) LDL levels. After we adjusted for patient sociodemographic, clinical, and facility-level characteristics by using hierarchical linear mixed modeling, none of these differences remained significant but INR goals for patients discharged on warfarin differed significantly by age. After we adjusted for patient and facility characteristics, fewer age differences were found in the postdischarge stroke QIs. Clinical trial registration was not required.

Key words: adult, aged, Department of Veteran Affairs, gender, medical record review, postdischarge care, quality of health care, risk factors, stroke, stroke severity.


View HTML  ¦  View PDF  ¦  Contents Vol. 50, No. 2
This article and any supplementary material should be cited as follows:
Chumbler NR, Jia H, Phipps MS, Li X, Ordin D, Williams LS, Myers LJ, Bravata DM. Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients? J Rehabil Res Dev. 2013;50(2):263–72.
http://dx.doi.org/10.1682/JRRD.2011.08.0145
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