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

Neale R. Chumbler, Huanguang Jia, Michael S. Phipps, Xinli Li, Diana Ordin, Linda S. Williams, Laura J. Myers, Dawn M. Bravata

Research output: Contribution to journalArticle

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) serumglycosylated hemoglobin, and (5) depression treatment. The mean age for the 3,196 veterans included in this study was67.2 +/- 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.

Original languageEnglish (US)
Pages (from-to)263-272
Number of pages10
JournalJournal of Rehabilitation Research and Development
Volume50
Issue number2
DOIs
StatePublished - May 3 2013

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Keywords

  • Adult
  • Aged
  • Department of Veteran Affairs
  • Gender
  • Medical record review
  • Postdischarge care
  • Quality of health care
  • Risk factors
  • Stroke
  • Stroke severity

ASJC Scopus subject areas

  • Rehabilitation

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