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

Chumbler, Neale R.
Jia, Huanguang
Phipps, Michael S.
Li, Xinli
Ordin, Diana
Williams, Linda S.
Myers, Laura J.
Bravata, Dawn M.
Abstract
Description
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 was 67.2 +/- 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.
Date
2013-01-01
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Publisher
University of Wyoming. Libraries
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Keywords
Quality of Health Care; Patient Discharge; After Care; Stroke -- Therapy; United States Department of Veterans Affairs; Healthcare Disparities , Medicine and Health Sciences
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