title: Correlation of inpatient and outpatient measures of stroke care quality within veterans health administration hospitals.
abstract: OBJECTIVE
  Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration. We examined the correlation between stroke care quality at hospital discharge and within 6 months postdischarge.
  
  
  METHODS
  We conducted a cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 Veterans Health Administration medical centers and 2380 veterans with postdischarge follow-up within 6 months in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of antithrombotic and antilipidmic therapy, anticoagulation for atrial fibrillation, and tobacco cessation counseling along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented postdischarge care quality: achievement of blood pressure, low-density lipoprotein, international normalized ratio, and glycosylated hemoglobin target levels, and delivery of appropriate treatment for poststroke depression along with a composite measure of achieved outcomes.
  
  
  RESULTS
  Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized postdischarge rates of achieving goal were 56% for blood pressure, 36% for low-density lipoprotein, 41% for international normalized ratio, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite 6-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the low-density lipoprotein goal (r=0.31; P=0.007) and depression management (r=0.27; P=0.03) goal but was not correlated with blood pressure, international normalized ratio, glycosylated hemoglobin goals, nor with the composite measure of achieved postdischarge outcomes (probability values >0.13).
  
  
  CONCLUSIONS
  Hospital discharge care quality was not consistently correlated with ambulatory care quality.
authors: Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CT, USA. joseph.ross@yale.edu
authors: Joseph S
authors: JS
authors: Ross
authors: Greg
authors: G
authors: Arling
authors: Susan
authors: S
authors: Ofner
authors: Christianne L
authors: CL
authors: Roumie
authors: Salomeh
authors: S
authors: Keyhani
authors: Linda S
authors: LS
authors: Williams
authors: Diana L
authors: DL
authors: Ordin
authors: Dawn M
authors: DM
authors: Bravata
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010351:Patient Discharge; D011787:Quality of Health Care; D020521:Stroke / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health