title: Postdischarge quality of care: do age disparities exist among Department of Veterans Affairs ischemic stroke patients?
abstract: This study examined whether age disparities existed across postdischarge quality indicators (QIs) for veterans with ischemic stroke who received care at Department of Veterans Affairs medical centers (VAMCs). This retrospective cohort included a national sample of 3,196 veterans who were diagnosed with ischemic stroke and received acute and postdischarge stroke care at 127 VAMCs in fiscal year 2007 (10/1/06 through 9/30/07). Data included an assessment of postdischarge stroke QIs in the outpatient setting during the 6 mo postdischarge. The QIs included measurement of and goal achievement for (1) blood pressure, (2) serum international normalized ratio (INR) for all patients discharged on warfarin, (3) cholesterol (low-density lipoprotein [LDL]) levels, (4) serum glycosylated hemoglobin, and (5) depression treatment. The mean age for the 3,196 veterans included in this study was 67.2 +/- 11.3 yr. Before risk adjustment, there were age differences in (1) depression screening/treatment, (2) blood pressure goals, and (3) LDL levels. After we adjusted for patient sociodemographic, clinical, and facility-level characteristics by using hierarchical linear mixed modeling, none of these differences remained significant but INR goals for patients discharged on warfarin differed significantly by age. After we adjusted for patient and facility characteristics, fewer age differences were found in the postdischarge stroke QIs. Clinical trial registration was not required.
authors.affiliation: Department of Health Policy and Management, University of Georgia, 110 E Clayton Street, Athens, GA 30602, USA. Chumbler@uga.edu
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: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000359:Aftercare / Q000592:standards*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002545:Brain Ischemia / Q000150:complications*; D008078:Cholesterol, LDL / Q000097:blood; D003863:Depression / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D054625:Healthcare Disparities; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin