title: Inpatient stroke care quality for veterans: are there differences between Veterans Affairs medical centers in the stroke belt and other areas?
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.
authors.affiliation: US Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Rehabilitation Outcomes Research Center, Gainesville, FL, USA.
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Michael
authors.initials: M
authors.lastname: Phipps
authors.forename: Dawn
authors.initials: D
authors.lastname: Bravata
authors.forename: Jaime
authors.initials: J
authors.lastname: Castro
authors.forename: Xinli
authors.initials: X
authors.lastname: Li
authors.forename: Diana
authors.initials: D
authors.lastname: Ordin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Myers
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Linda
authors.initials: L
authors.lastname: Williams
authors.forename: Neale
authors.initials: N
authors.lastname: Chumbler
mesh_terms: D000368:Aged; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*