title: Does inpatient quality of care differ by age among US veterans with ischemic stroke?
abstract: BACKGROUND
  Some studies have found that older individuals are not as likely as their younger counterparts to be treated with some guideline-based stroke therapies. We examined whether age-related differences in inpatient quality of care exist among US veterans with ischemic stroke.
  
  
  METHODS
  This was a retrospective study of a national sample of veterans admitted to 129 Veterans Affairs medical centers for ischemic stroke during fiscal year 2007. Inpatient stroke care quality was examined across 14 inpatient processes of care, including dysphagia screening, National Institutes of Health Stroke Scale (NIHSS) score documentation, thrombolysis, deep venous thrombosis prophylaxis, antithrombotic therapy by hospital day 2 and at discharge, early ambulation, fall risk assessment, pressure ulcer risk assessment, rehabilitation needs assessment, atrial fibrillation management, lipid management, smoking cessation counseling, and stroke education.
  
  
  RESULTS
  Among the 3939 veterans with ischemic stroke, the mean age was 67.8 years (standard deviation, 11.5). The overall performance rate was >70% for 10 of the 14 quality indicators. In unadjusted analyses, older patients were less likely to receive lipid management, smoking cessation, NIHSS documentation, and early ambulation compared with younger patients; conversely, older patients were more likely to receive dysphagia screening and stroke education. After adjusting for demographic, clinical, and hospital level characteristics, the age-related differences in processes of care were less consistent; however, the youngest patients were more likely to receive smoking cessation counseling and the oldest patients were less likely to receive lipid management.
  
  
  CONCLUSIONS
  Risk-adjusted inpatient stroke care quality varies little with age for veterans admitted to a Veterans Affairs medical center for acute ischemic stroke.
authors.affiliation: Veterans Affairs Health Services Research and Development, Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. neale.chumbler@va.gov
authors.forename: Neale R
authors.initials: NR
authors.lastname: Chumbler
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Michael S
authors.initials: MS
authors.lastname: Phipps
authors.forename: Xinli
authors.initials: X
authors.lastname: Li
authors.forename: Diana
authors.initials: D
authors.lastname: Ordin
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Jaime G
authors.initials: JG
authors.lastname: Castro
authors.forename: Jennifer
authors.initials: J
authors.lastname: Myers
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D016009:Chi-Square Distribution; D003376:Counseling / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D004185:Disability Evaluation; D004434:Early Ambulation / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006787:Hospitals, Veterans; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007297:Inpatients; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D016540:Smoking Cessation; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000592:standards*
chemical_list: D000960:Hypolipidemic Agents