BACKGROUND/RATIONALE:
The Stroke Executive Committee identified important areas in the prevention and treatment of stroke for the veteran population. Our goal was to identify projects along the continuum from preventing initial strokes, improving outcomes for patients with stroke, to identifying post-stroke rehabilitation strategies that preserve function in the optimum setting. By identifying gaps in the existing knowledge base we have proposed recommendations for closing those gaps either through short-term or long-term inquiry. In some cases (e.g., anticoagulation clinic services) the VA leads the country in available research; therefore, national policy for implementing these clinics may significantly reduce stroke rates for patients with atrial fibrillation. In other areas (e.g., carotid endarterectomy) data bases exist that would help advance quality and outcomes, but short-term studies are necessary to establish their utility. Lastly, some areas will require larger prospective studies before policy can be established. Our general outline for considering topics covers a longitudinal spectrum.
OBJECTIVE(S):
To promote strategic improvement in the prevention and management of stroke in the VA, we have identified six strategic opportunities: 1) identification of core processes for anticoagulation clinic services; 2) enhanced understanding and proposed interventions designed to improve control of BP in patients with hypertension; 3) risk-adjusted models for carotid endarterectomy directed to understanding the facility variation in outcome; 4) definition of a systematic acute stroke management system; 5) assess the impact of post-stroke rehabilitation location, prognostication and benefit; and
6) evaluate measures assessing quality of life for patients with stroke.
METHODS:
For each module we have identified strategic objectives with specific products to be delivered within two years. Some products (e.g., surveys, implementation of recommendations) should be complete within one year. Other recommendations include larger scale studies that would best be handled through supplemental request for proposals. The Stroke Executive Committee will serve to coordinate the short-term studies playing a major role in conducting these efforts, generating reports, manuscripts and action plans for the Research and Methodology Committee. This will be managed through close collaboration between the Research and Clinical Coordinators of the Committee though regular input from committee members.
FINDINGS/RESULTS:
Pending.
IMPACT:
We see this effort as an opportunity for VHA to take a national leadership role in stroke prevention, treatment, and rehabilitation.
PUBLICATIONS:
Journal Articles
- Oddone E, Brass LM, Booss J, Goldstein L, Alley L, Horner R, Rosen A, Kaplan L. Quality Enhancement Research Initiative in stroke: prevention, treatment, and rehabilitation. Medical Care. 2000; 38(6 Suppl 1): I92-104.
- Oddone E, Horner R, Matchar D. Racial inequity of access to carotid imaging - Response. Stroke; A Journal of Cerebral Circulation. 1999; 1999 Nov(11): 2491.
- Oddone EZ. Primary Stroke Prevention. VA Practice Matters. 1999; 4(1): 1-4.
