Inpatient stroke care quality for veterans: Are there differences between Veterans Affairs medical centers in the stroke belt and other areas?

Huanguang Jia, Michael Phipps, Dawn Bravata, Jaime Castro, Xinli Li, Diana Ordin, Jennifer Myers, W. Bruce Vogel, Linda Williams, Neale Chumbler

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Stroke mortality has been found to be much higher among residents in the stroke belt region than in the rest of United States, but it is not known whether differences exist in the quality of stroke care provided in Department of Veterans Affairs medical centers in states inside and outside this region. Objective: We compared mortality and inpatient stroke care quality between Veterans Affairs medical centers inside and outside the stroke belt region. Methods: Study patients were veterans hospitalized for ischemic stroke at 129 Veterans Affairs medical centers. Inpatient stroke care quality was assessed by 14 quality indicators. Multivariable logistic regression models were fit to examine differences in quality between facilities inside and outside the stroke belt, adjusting for patient characteristics and Veterans Affairs medical centers clustering effect. Results: Among the 3909 patients, 28·1% received inpatient ischemic stroke care in 28 stroke belt Veterans Affairs medical centers, and 71·9% obtained care in 101 non-stroke belt Veterans Affairs medical centers. Patients cared for in stroke belt Veterans Affairs medical centers were more likely to be younger, Black, married, have a higher stroke severity, and less likely to be ambulatory pre-stroke. We found no statistically significant differences in short- and long-term post-admission mortality and inpatient care quality indicators between the patients cared for in stroke belt and non-stroke belt Veterans Affairs medical centers after risk adjustment. Conclusions: These data suggest that a stroke belt does not exist within the Veterans Affairs health care system in terms of either post-admission mortality or inpatient care quality.

Original languageEnglish
Pages (from-to)67-72
Number of pages6
JournalInternational Journal of Stroke
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Quality of Health Care
Veterans
Inpatients
Stroke
Mortality
Logistic Models
Veterans Health
Risk Adjustment
Cluster Analysis

Keywords

  • Acute
  • Acute stroke therapy
  • Ischemic stroke
  • Stroke facilities
  • Stroke units
  • Treatment

ASJC Scopus subject areas

  • Neurology
  • Medicine(all)

Cite this

Inpatient stroke care quality for veterans : Are there differences between Veterans Affairs medical centers in the stroke belt and other areas? / Jia, Huanguang; Phipps, Michael; Bravata, Dawn; Castro, Jaime; Li, Xinli; Ordin, Diana; Myers, Jennifer; Vogel, W. Bruce; Williams, Linda; Chumbler, Neale.

In: International Journal of Stroke, Vol. 10, No. 1, 01.01.2015, p. 67-72.

Research output: Contribution to journalArticle

Jia, Huanguang ; Phipps, Michael ; Bravata, Dawn ; Castro, Jaime ; Li, Xinli ; Ordin, Diana ; Myers, Jennifer ; Vogel, W. Bruce ; Williams, Linda ; Chumbler, Neale. / Inpatient stroke care quality for veterans : Are there differences between Veterans Affairs medical centers in the stroke belt and other areas?. In: International Journal of Stroke. 2015 ; Vol. 10, No. 1. pp. 67-72.
@article{f385361720d24c7f9391cbf34e52af6d,
title = "Inpatient stroke care quality for veterans: Are there differences between Veterans Affairs medical centers in the stroke belt and other areas?",
abstract = "Background: Stroke mortality has been found to be much higher among residents in the stroke belt region than in the rest of United States, but it is not known whether differences exist in the quality of stroke care provided in Department of Veterans Affairs medical centers in states inside and outside this region. Objective: We compared mortality and inpatient stroke care quality between Veterans Affairs medical centers inside and outside the stroke belt region. Methods: Study patients were veterans hospitalized for ischemic stroke at 129 Veterans Affairs medical centers. Inpatient stroke care quality was assessed by 14 quality indicators. Multivariable logistic regression models were fit to examine differences in quality between facilities inside and outside the stroke belt, adjusting for patient characteristics and Veterans Affairs medical centers clustering effect. Results: Among the 3909 patients, 28·1{\%} received inpatient ischemic stroke care in 28 stroke belt Veterans Affairs medical centers, and 71·9{\%} obtained care in 101 non-stroke belt Veterans Affairs medical centers. Patients cared for in stroke belt Veterans Affairs medical centers were more likely to be younger, Black, married, have a higher stroke severity, and less likely to be ambulatory pre-stroke. We found no statistically significant differences in short- and long-term post-admission mortality and inpatient care quality indicators between the patients cared for in stroke belt and non-stroke belt Veterans Affairs medical centers after risk adjustment. Conclusions: These data suggest that a stroke belt does not exist within the Veterans Affairs health care system in terms of either post-admission mortality or inpatient care quality.",
keywords = "Acute, Acute stroke therapy, Ischemic stroke, Stroke facilities, Stroke units, Treatment",
author = "Huanguang Jia and Michael Phipps and Dawn Bravata and Jaime Castro and Xinli Li and Diana Ordin and Jennifer Myers and Vogel, {W. Bruce} and Linda Williams and Neale Chumbler",
year = "2015",
month = "1",
day = "1",
doi = "10.1111/j.1747-4949.2012.00861.x",
language = "English",
volume = "10",
pages = "67--72",
journal = "International Journal of Stroke",
issn = "1747-4930",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Inpatient stroke care quality for veterans

T2 - Are there differences between Veterans Affairs medical centers in the stroke belt and other areas?

AU - Jia, Huanguang

AU - Phipps, Michael

AU - Bravata, Dawn

AU - Castro, Jaime

AU - Li, Xinli

AU - Ordin, Diana

AU - Myers, Jennifer

AU - Vogel, W. Bruce

AU - Williams, Linda

AU - Chumbler, Neale

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Stroke mortality has been found to be much higher among residents in the stroke belt region than in the rest of United States, but it is not known whether differences exist in the quality of stroke care provided in Department of Veterans Affairs medical centers in states inside and outside this region. Objective: We compared mortality and inpatient stroke care quality between Veterans Affairs medical centers inside and outside the stroke belt region. Methods: Study patients were veterans hospitalized for ischemic stroke at 129 Veterans Affairs medical centers. Inpatient stroke care quality was assessed by 14 quality indicators. Multivariable logistic regression models were fit to examine differences in quality between facilities inside and outside the stroke belt, adjusting for patient characteristics and Veterans Affairs medical centers clustering effect. Results: Among the 3909 patients, 28·1% received inpatient ischemic stroke care in 28 stroke belt Veterans Affairs medical centers, and 71·9% obtained care in 101 non-stroke belt Veterans Affairs medical centers. Patients cared for in stroke belt Veterans Affairs medical centers were more likely to be younger, Black, married, have a higher stroke severity, and less likely to be ambulatory pre-stroke. We found no statistically significant differences in short- and long-term post-admission mortality and inpatient care quality indicators between the patients cared for in stroke belt and non-stroke belt Veterans Affairs medical centers after risk adjustment. Conclusions: These data suggest that a stroke belt does not exist within the Veterans Affairs health care system in terms of either post-admission mortality or inpatient care quality.

AB - Background: Stroke mortality has been found to be much higher among residents in the stroke belt region than in the rest of United States, but it is not known whether differences exist in the quality of stroke care provided in Department of Veterans Affairs medical centers in states inside and outside this region. Objective: We compared mortality and inpatient stroke care quality between Veterans Affairs medical centers inside and outside the stroke belt region. Methods: Study patients were veterans hospitalized for ischemic stroke at 129 Veterans Affairs medical centers. Inpatient stroke care quality was assessed by 14 quality indicators. Multivariable logistic regression models were fit to examine differences in quality between facilities inside and outside the stroke belt, adjusting for patient characteristics and Veterans Affairs medical centers clustering effect. Results: Among the 3909 patients, 28·1% received inpatient ischemic stroke care in 28 stroke belt Veterans Affairs medical centers, and 71·9% obtained care in 101 non-stroke belt Veterans Affairs medical centers. Patients cared for in stroke belt Veterans Affairs medical centers were more likely to be younger, Black, married, have a higher stroke severity, and less likely to be ambulatory pre-stroke. We found no statistically significant differences in short- and long-term post-admission mortality and inpatient care quality indicators between the patients cared for in stroke belt and non-stroke belt Veterans Affairs medical centers after risk adjustment. Conclusions: These data suggest that a stroke belt does not exist within the Veterans Affairs health care system in terms of either post-admission mortality or inpatient care quality.

KW - Acute

KW - Acute stroke therapy

KW - Ischemic stroke

KW - Stroke facilities

KW - Stroke units

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=84915811158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84915811158&partnerID=8YFLogxK

U2 - 10.1111/j.1747-4949.2012.00861.x

DO - 10.1111/j.1747-4949.2012.00861.x

M3 - Article

C2 - 22974516

AN - SCOPUS:84915811158

VL - 10

SP - 67

EP - 72

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 1

ER -