title: Quality Enhancement Research Initiative in stroke: prevention, treatment, and rehabilitation.
abstract: Stroke is the third leading cause of death and a leading cause of adult disability in the United States. Both within and outside of the Veterans Health Administration (VHA), the lack of a systematic approach to stroke prevention and treatment may have contributed to reduced rates of compliance with recommended practices and increased rates of stroke. Gaps in the knowledge base inhibit a systematic approach to high-quality care within the veteran population. Initial recommendations for closing those gaps are proposed. In some cases (eg, systematic anticoagulation management), the VHA is perceived as a leader in applied research; therefore, a systematic national policy for implementing these clinics may significantly reduce stroke rates. In other areas (eg, carotid endarterectomy), databases exist that would help advance quality and outcomes, but short-term studies are necessary to establish their utility. To promote strategic improvement in prevention, treatment, and rehabilitation for veterans who may be at risk or have had a stroke, specific objectives are proposed to (1) identify best practices for the effective delivery of long-term anticoagulation and enhance veterans' access to these services, (2) develop risk-adjusted models for the surgical preventive procedure carotid endarterectomy to understand facility variation in outcomes so practices can be improved, (3) define a systematic acute stroke management system so that high-quality stroke-related care can be generalizable to a variety of VHA settings, and (4) assess the impact of poststroke rehabilitation on risk adjustment and the location of outcomes so as to facilitate the implementation of best rehabilitation practices.
authors.affiliation: HSR&D Field Program, Durham, North Carolina, USA. oddon001@mc.duke.edu
authors.forename: E
authors.initials: E
authors.lastname: Oddone
authors.forename: L M
authors.initials: LM
authors.lastname: Brass
authors.forename: J
authors.initials: J
authors.lastname: Booss
authors.forename: L
authors.initials: L
authors.lastname: Goldstein
authors.forename: L
authors.initials: L
authors.lastname: Alley
authors.forename: R
authors.initials: R
authors.lastname: Horner
authors.forename: A
authors.initials: A
authors.lastname: Rosen
authors.forename: L
authors.initials: L
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D019985:Benchmarking / Q000458:organization & administration; D002423:Cause of Death; D016208:Databases, Factual; D004282:Documentation / Q000379:methods / Q000592:standards; D016894:Endarterectomy, Carotid; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011788:Quality of Life; D012046:Rehabilitation / Q000379:methods / Q000592:standards; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*