Stroke, TIA Quality of Care Varies Across Facilities

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Higher performance in care was seen in admitted patients compared with patients cared for only in the emergency department.
Higher performance in care was seen in admitted patients compared with patients cared for only in the emergency department.

HealthDay News — Care quality for patients with transient ischemic attack (TIA) or minor stroke varies substantially across elements of care and facilities, according to a study published in JAMA Neurology.

Dawn M. Bravata, MD, from the Department of Veterans Affairs (VA) Health Services Research and Development Stroke Quality Enhancement Research Initiative in Washington, DC, and colleagues examined the quality of guideline-recommended care for 8201 patients with TIA or minor stroke receiving care in the Veterans Health Administration system during federal fiscal year 2014.

The researchers found that there was variation in performance across elements of care: brain imaging by day 2 (88.9%), antithrombotic use by day 2 (83.8%), hemoglobin A1c measurement by discharge or within the previous 120 days (82.5%), anticoagulation for atrial fibrillation by day 7 after discharge (82.1%), deep vein thrombosis prophylaxis by day 2 (74.9%), hypertension control by 90 days after discharge (71.8%), neurology consultation by day 1 (70.6%), electrocardiography by day 2 or within 1 day prior (67%), carotid artery imaging by day 2 or within six months previously (64.1%), and moderate- to high-potency statin prescription by day 7 after discharge (47.2%). Performance varied substantially across facilities, and higher performance was seen for admitted patients than for patients cared for only in the emergency departments.

"Health care systems should engage in ongoing TIA care performance assessment to complement existing stroke performance measurement," the authors wrote

Reference

Bravata DM, Myers LJ, Arling G, et al. Quality of care for veterans with transient ischemic attack and minor stroke [published online February 5, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.4648

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