Measuring Health Related Quality of Life in Veterans with Stroke
Dean M. Reker PhD RN BS
Edward Hines, Jr. VA Hospital
Hines, IL
Funding Period: January 2001 - March 2003

BACKGROUND/RATIONALE:
Approximately 11,000 veterans annually are hospitalized with a newly acquired incident stroke. Based on American Heart Association ratios of stroke incidence and prevalence, up to 80,000 veterans may be stroke survivors. The assessment of outcomes in stroke survivors is important for clinical practice and research, yet there is no consensus on the best measures of stroke outcome in either clinical practice or research. We have developed a new stroke-specific outcome measure, the Stroke Impact Scale (SIS), to capture physical function and other dimensions of health-related quality of life.

OBJECTIVE(S):
The major research questions in this investigation are: 1) Does the SIS have concurrent and discriminate validity in a veteran stroke population when compared to the FIM, Rankin, and the SF-36V? 2) What effect does mode of administration have on response rates, bias, data quality, reliability and validity, SIS domain scores, and cost of data collection? 3) What factors differentiate responders and non-responders? 4) Will the SIS scores predict health care costs and utilization?

METHODS:
Using ICD-9 discharge codes and electronic medical records, patients were screened for a valid diagnosis of stroke. At three months post-stroke, patients were randomly assigned to receive a mailed SIS instrument or SIS via telephone interview. At four months post-stroke, all respondents were evaluated using the Functional Independence Measure and SF-36V by telephone.

FINDINGS/RESULTS:
Four hundred fifty-eight of 943 screened subjects in 13 VA sites of care were identified to have stroke and were randomly assigned to either a mail (n=223) or telephone survey (n=235). Response rate to the mailed survey was 44 percent and 58 percent for the telephone survey.

IMPACT:
Establishing the feasibility and use of the SIS in a veteran population is the first step in quantifying meaningful outcomes for VA stroke patients. Once established, the SIS could be used as a universal, multi-dimension stroke outcome tool to assess patient outcomes and assist in the measurement of provider performance, best practices, cost-effectiveness of stroke interventions, and quality of care.

PUBLICATIONS:

Journal Articles

1. Kwon S, Duncan P, Studenski S, Perera S, Lai SM, Reker D. Measuring stroke impact with SIS: construct validity of SIS telephone administration. Quality of Life Research. 2006; 15(3): 367-76.
2. Duncan P, Reker D, Kwon S, Lai SM, Studenski S, Perera S, Alfrey C, Marquez J. Measuring stroke impact with the stroke impact scale: telephone versus mail administration in veterans with stroke. Medical Care. 2005; 43(5): 507-15.
3. Jia H, Uphold CR, Wu S, Reid K, Findley K, Duncan PW. Health-related quality of life among men with HIV infection: effects of social support, coping, and depression. AIDS Patient Care and Stds. 2004; 18(10): 594-603.
4. Duncan PW, Reker DM, Horner RD, Samsa GP, Hoenig H, LaClair BJ, Dudley TK. Performance of a mail-administered version of a stroke-specific outcome measure, the Stroke Impact Scale. Clinical Rehabilitation. 2002; 16(5): 493-505.

DRA: Chronic Diseases, Health Services and Systems
DRE: Quality of Care, Resource Use and Cost
Keywords: Chronic disease (other & unspecified), VA/non-VA comparisons
MeSH Terms: none