Quality of Care for Veterans with Stroke Did Not Diminish During Pandemic
BACKGROUND:
Hospitalizations for acute ischemic stroke (AIS) and transient ischemic attack (TIA) decreased during the COVID-19 pandemic. This retrospective cohort study compared the quality of care and outcomes for patients with AIS/TIA before vs during the COVID-19 pandemic across the VA healthcare system. Using VA data, investigators identified Veterans with an emergency department visit or inpatient stay for AIS or TIA from 2016-2020 at any of 128 VA hospitals. The primary analysis compared quality of care for patients in March-September 2019 (5,636 Veterans; 1,916 with TIA and 3,720 with stroke) versus March-September 2020 (4,360 Veterans; 1,334 with TIA and 3,026 with stroke). Investigators also examined quality of care over time from March through September of each year (2016-2018). Investigators used the ‘without-fail rate’ as an all-or-none composite measure of quality, which evaluated whether patients had received all of the processes of care for which they were eligible.
FINDINGS:
- The overall quality of care did not diminish among Veterans with stroke and TIA who received care in VA facilities during the COVID-19 pandemic. As measured by the without-fail rate, quality of care improved from 50% in 2019 to 56% in 2020.
- The without-fail rate remained relatively stable for Veterans with TIA (44% in 2019 vs 44% in 2020) and increased for Veterans with stroke (54% in 2019 vs 62% in 2020).
- Fewer patients were eligible for the hypertension control measure in 2020 than in prior years due to lack of blood pressure (BP) measurements: 31% in 2020 vs 67% in prior years, likely explained by fewer patients having a primary care visit in the 90 days after discharge. When measured, BP was not as well controlled during the pandemic period (72%) as during the pre-pandemic period (78%).
IMPLICATIONS:
- Healthcare providers should ensure that patients who have had an AIS/TIA receive priority as healthcare systems address deferred primary care, particularly hypertension management.
LIMITATIONS:
- This study evaluated care for patients who presented with stroke or TIA; it could not assess the possibility that some patients with symptoms never sought care during the pandemic. It also focused on stroke and TIA from typical causes; patients who were admitted for COVID-19 who had concomitant stroke/TIA or developed an index event during an admission for COVID-19 were not included.
AUTHOR/FUNDING INFORMATION:
This study was supported through the EXTEND QUERI program. Drs. Myers and Bravata and Mr. Perkins are part of EXTEND QUERI. Drs. Myers and Bravata also are part of HSR&D’s Center for Health Information and Communication (CHIC).
Myers L, Perkins AJ, Kilkenny M, and Bravata DM. Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic. Journal of Stroke and Cerebrovascular Diseases. April 5, 2022;31(6):106455 online ahead of print.
