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Aim

Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients?. Neale R. Chumbler, PhD; Huanguang Jia; Michael S. Phipps, MD; Xinli Li, PhD; Diana Ordin, MD, MPH; Linda S. Williams, MD; Laura J. Myers, PhD; Dawn M. Bravata, MD. Aim

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  1. Postdischarge quality of care: Do age disparities exist amongDepartment of Veterans Affairs ischemic stroke patients? Neale R. Chumbler, PhD; Huanguang Jia; Michael S. Phipps, MD; Xinli Li, PhD; Diana Ordin, MD, MPH; Linda S. Williams, MD; Laura J. Myers, PhD; Dawn M. Bravata, MD

  2. Aim • Examine whether age disparities exist in postdischarge quality indicators (QIs) for veterans with ischemic stroke who receive care at Department of Veterans Affairs medical centers (VAMCs). • Relevance • Some previous studies have found age differences in care processes, but whether these same differences exist in VAMC stroke care is unclear.

  3. Method • Retrospective cohort of 3,196 veterans. • Diagnosed with ischemic stroke. • Received acute and postdischarge stroke care at 127 VAMCs in fiscal year 2007. • Assessed postdischarge stroke QIs in outpatient setting over 6 mo: • Blood pressure. • Serum international normalized ratio (INR). • Cholesterol levels. • Serum glycosylated hemoglobin. • Depression treatment.

  4. Results • After adjustment for sociodemographic, clinical, and facility-level characteristics, only postdischarge INR control differed by age. • Substantially higher for veterans 85 and older. • Neither unadjusted nor adjusted results demon-strated consistent decrement in quality with increasing age. • Rather, some care processes provided more often to older patients (cholesterol goal achievement) and others provided more often to younger patients (depression treatment and blood pressure goal achievement).

  5. Conclusion • Overall postdischarge quality for ischemic stroke in VAMCs did not vary consistently by age. • However, the few differences that emerged should encourage awareness of possible age disparities. • Stroke management should be guided by best clinical evidence and guidelines, irrespective of age.

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