Quality Enhancement Research Initiative in stroke: prevention, treatment, and rehabilitation.

Abstract

Stroke is the third leading cause of death and a leading cause of adult disability in the United States. Both within and outside of the Veterans Health Administration (VHA), the lack of a systematic approach to stroke prevention and treatment may have contributed to reduced rates of compliance with recommended practices and increased rates of stroke. Gaps in the knowledge base inhibit a systematic approach to high-quality care within the veteran population. Initial recommendations for closing those gaps are proposed. In some cases (eg, systematic anticoagulation management), the VHA is perceived as a leader in applied research; therefore, a systematic national policy for implementing these clinics may significantly reduce stroke rates. In other areas (eg, carotid endarterectomy), databases exist that would help advance quality and outcomes, but short-term studies are necessary to establish their utility. To promote strategic improvement in prevention, treatment, and rehabilitation for veterans who may be at risk or have had a stroke, specific objectives are proposed to (1) identify best practices for the effective delivery of long-term anticoagulation and enhance veterans' access to these services, (2) develop risk-adjusted models for the surgical preventive procedure carotid endarterectomy to understand facility variation in outcomes so practices can be improved, (3) define a systematic acute stroke management system so that high-quality stroke-related care can be generalizable to a variety of VHA settings, and (4) assess the impact of poststroke rehabilitation on risk adjustment and the location of outcomes so as to facilitate the implementation of best rehabilitation practices.

• Authors: E Oddone, L M Brass, J Booss, L Goldstein, L Alley, R Horner, A Rosen, L Kaplan
• Journal: Medical care (Med Care) Vol. 38 Issue 6 Suppl 1 Pg. I92-104 (Jun 2000) ISSN: 0025-7079 [Print] United States
• PMID: 10843274 (Publication Type: Journal Article, Review)

Topics

• Adult
• Benchmarking (organization & administration)
• Cause of Death
• Databases, Factual
• Documentation (methods, standards)
• Endarterectomy, Carotid
• Health Services Research (organization & administration)
• Humans
• Outcome and Process Assessment, Health Care (organization & administration)
• Practice Patterns, Physicians' (standards, statistics & numerical data)
• Quality of Life
• Rehabilitation (methods, standards)
• Risk Factors
• Stroke (complications, mortality, psychology, therapy)
• Total Quality Management (organization & administration)
• United States (epidemiology)
• United States Department of Veterans Affairs (organization & administration)