Rural-Urban differences in inpatient quality of care in US veterans with ischemic stroke

Michael S. Phipps, Huanguang Jia, Neale R. Chumbler, Xinli Li, Jaime G. Castro, Jennifer Myers, Linda Williams, Dawn Bravata

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: Differences in stroke care quality for patients in rural and urban locations have been suggested, but whether differences exist across Veteran Administration Medical Centers (VAMCs) is unknown. This study examines whether rural-urban disparities exist in inpatient quality among veterans with acute ischemic stroke. Methods: In this retrospective study, inpatient stroke care quality was assessed in a national sample of veterans with acute ischemic stroke using 14 quality indicators (QIs). Rural-Urban Commuting Areas codes defined each VAMC's rural-urban status. A hierarchical linear model assessed the rural-urban differences across the 14 QIs, adjusting for patient and facility characteristics, and clustering within VAMCs. Findings: Among 128 VAMCs, 18 (14.1%) were classified as rural VAMCs and admitted 284 (7.3%) of the 3,889 ischemic stroke patients. Rural VAMCs had statistically significantly lower unadjusted rates on 6 QIs: Deep vein thrombosis (DVT) prophylaxis, antithrombotic at discharge, antithrombotic at day 2, lipid management, smoking cessation counseling, and National Institutes of Health Stroke Scale completion, but they had higher rates of stroke education, functional assessment, and fall risk assessment. After adjustment, differences in 2 QIs remained significant-patients treated in rural VAMCs were less likely to receive DVT prophylaxis, but more likely to have documented functional assessment. Conclusions: After adjustment for key demographic, clinical, and facility-level characteristics, there does not appear to be a systematic difference in inpatient stroke quality between rural and urban VAMCs. Future research should seek to understand the few differences in care found that could serve as targets for future quality improvement interventions.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalJournal of Rural Health
Volume30
Issue number1
DOIs
StatePublished - Dec 2014

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Quality of Health Care
United States Department of Veterans Affairs
Veterans
Inpatients
Stroke
Venous Thrombosis
Social Adjustment
National Institutes of Health (U.S.)
Smoking Cessation
Quality Improvement
Cluster Analysis
Counseling
Linear Models
Patient Care
Retrospective Studies
Demography
Lipids
Education

Keywords

  • Geography
  • Health disparities
  • Health services research
  • Quality
  • Veterans

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Medicine(all)

Cite this

Rural-Urban differences in inpatient quality of care in US veterans with ischemic stroke. / Phipps, Michael S.; Jia, Huanguang; Chumbler, Neale R.; Li, Xinli; Castro, Jaime G.; Myers, Jennifer; Williams, Linda; Bravata, Dawn.

In: Journal of Rural Health, Vol. 30, No. 1, 12.2014, p. 1-6.

Research output: Contribution to journalArticle

Phipps, Michael S. ; Jia, Huanguang ; Chumbler, Neale R. ; Li, Xinli ; Castro, Jaime G. ; Myers, Jennifer ; Williams, Linda ; Bravata, Dawn. / Rural-Urban differences in inpatient quality of care in US veterans with ischemic stroke. In: Journal of Rural Health. 2014 ; Vol. 30, No. 1. pp. 1-6.
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