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The Quality of In-hospital Care for Veterans With Ischemic Stroke

Bravata DM, Myers JL, Arling GW, Ordin DL, Vogel WB, Williams LS. The Quality of In-hospital Care for Veterans With Ischemic Stroke. Paper presented at: American Heart Association / American Stroke Association International Stroke Conference; 2010 Feb 23; San Antonio, TX.


Background: Indicators of quality for acute stroke care have been developed by several organizations including the Joint Commission (JC). To date, the Department of Veterans Affairs (VA) has not systematically assessed quality of inpatient stroke care in VA facilities. Objectives: The objective of this project was to measure inpatient stroke care quality using both JC and VA-specific performance measures across the VA system. Methods: Veterans admitted to a VA hospital with a primary discharge diagnosis code of ischemic stroke in fiscal year 2007 were identified (N_5721) from the VA administrative data. A sample of 5000 medical records was identified using an approach that included all veterans at small volume centers (_55 annual ischemic stroke admissions) and 80% of veterans at high volume centers (_55 stroke admissions). Medical records were reviewed to assess the performance on 14 quality measures. Results: These data suggest that performance varies considerably across quality measures and across facilities. For example, relatively high rates of eligible patients are being treated with antithrombotic medications and receive smoking cessation counseling. The data suggest opportunities for improvement, with relatively few eligible patients receiving thrombolytic therapy, stroke education, or dysphagia screening prior to oral intake. Conclusions: This project provides benchmark data about VA performance on inpatient stroke care; and is the first assessment of stroke care quality from a large integrated U.S. healthcare system. These data suggest that VA stroke care quality is comparable to or better than non-VA care for many processes, but opportunities for improvement exist for some processes of care. These data have been used by VA Patient Care Services and the Stroke Quality Enhancement Research Initiative program to identify targets for quality improvement projects. Several implementation projects are either underway or about to be instituted to improve care for veterans with stroke.

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