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

Authors

  • Huanguang Jia,

    Corresponding author
    1. US Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Rehabilitation Outcomes Research Center, Gainesville, FL, USA
    • Correspondence: Huanguang Jia, US Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Rehabilitation Outcomes Research Center, 1601 SW Archer Road, Gainesville, FL 32608, USA.

      E-mail: huanguang.jia@va.gov

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  • Michael Phipps,

    1. Yale University School of Medicine, Robert Wood Johnson Foundation Clinical Scholars Program and the Department of Neurology, New Haven, CT, USA
    2. VA Connecticut Healthcare System, West Haven, CT, USA
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  • Dawn Bravata,

    1. Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Indianapolis, IN, USA
    2. VA HSR&D Stroke Quality Enhancement Research Initiative (Stroke QUERI), Indianapolis, IN, USA
    3. Regenstrief Institute, Indianapolis, IN, USA
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  • Jaime Castro,

    1. US Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Rehabilitation Outcomes Research Center, Gainesville, FL, USA
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  • Xinli Li,

    1. VA National Surgery Office, Denver, CO, USA
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  • Diana Ordin,

    1. Department of Veterans Affairs, Veterans Health Administration, Office of Analytics and Business Intelligence, Washington, DC, USA
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  • Jennifer Myers,

    1. Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Indianapolis, IN, USA
    2. VA HSR&D Stroke Quality Enhancement Research Initiative (Stroke QUERI), Indianapolis, IN, USA
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  • W. Bruce Vogel,

    1. US Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Rehabilitation Outcomes Research Center, Gainesville, FL, USA
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  • Linda Williams,

    1. Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Indianapolis, IN, USA
    2. VA HSR&D Stroke Quality Enhancement Research Initiative (Stroke QUERI), Indianapolis, IN, USA
    3. Regenstrief Institute, Indianapolis, IN, USA
    4. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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  • Neale Chumbler

    1. Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Indianapolis, IN, USA
    2. VA HSR&D Stroke Quality Enhancement Research Initiative (Stroke QUERI), Indianapolis, IN, USA
    3. Regenstrief Institute, Indianapolis, IN, USA
    4. Department of Sociology, Indiana University School of Liberal Arts, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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  • Conflict of Interest: None declared.

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.

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