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.
Highlights
Older age is one of the most common nonmodifiable risk factors for ischemic stroke [1]
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)
Summary
Older age is one of the most common nonmodifiable risk factors for ischemic stroke [1]. Individuals in the older age groups (60–69, 70–79, and 80 yr) were significantly more likely than their younger counterparts to be discharged with antihypertensive treatment. A separate study found that older individuals (85+ yr) were less likely to receive secondary prevention (e.g., documented measure of blood cholesterol) [11]. Using a nationally representative telephone self-report survey to explore disparities in 11 stroke secondary prevention services (e.g., serum glycosylated hemoglobin [HbA1c] measurement; serum cholesterol measurement), Ross and colleagues reported that individuals younger than 65 were less likely than those 65–79 to report receipt of recommended services (e.g., serum cholesterol measurement) [12].
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