Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration.
Administrative Claims, Healthcare
Adult
Aged
Aged, 80 and over
Emergency Service, Hospital
Female
Humans
Ischemic Attack, Transient
/ diagnostic imaging
Male
Middle Aged
Neurology
Patient Admission
Quality of Health Care
/ standards
Referral and Consultation
Retrospective Studies
Stroke
/ prevention & control
Time Factors
United States
United States Department of Veterans Affairs
Veterans
chronic disease management
health services research
performance measures
quality measurement
statistics
Journal
BMJ open quality
ISSN: 2399-6641
Titre abrégé: BMJ Open Qual
Pays: England
ID NLM: 101710381
Informations de publication
Date de publication:
2019
2019
Historique:
received:
18
01
2019
revised:
22
10
2019
accepted:
23
11
2019
entrez:
8
1
2020
pubmed:
8
1
2020
medline:
14
7
2020
Statut:
epublish
Résumé
Timely preventive care can substantially reduce risk of recurrent vascular events or death after a transient ischaemic attack (TIA). Our objective was to understand patient and facility factors influencing preventive care quality for patients with TIA in the US Veterans Health Administration (VHA). We analysed administrative data from a retrospective cohort of 3052 patients with TIA cared for in the emergency department (ED) or inpatient setting in 110 VHA facilities from October 2010 to September 2011. A composite quality indicator (QI score) pass rate was constructed from four process-related quality measures-carotid imaging, brain imaging, high or moderate potency statin and antithrombotic medication, associated with the ED visit or inpatient admission after the TIA. We tested a multilevel structural equation model where facility and patient characteristics, inpatient admission, and neurological consultation were predictors of the resident's composite QI score. Presenting with a speech deficit and higher Charlson Comorbidity Index (CCI) were positively related to inpatient admission. Being admitted increased the likelihood of neurology consultation, whereas history of dementia, weekend arrival and a higher CCI score made neurological consultation less likely. Speech deficit, higher CCI, inpatient admission and neurological consultation had direct positive effects on the composite quality score. Patients in facilities with fewer full-time equivalent neurology staff were less likely to be admitted or to have a neurology consultation. Facilities having greater organisational complexity and with a VHA stroke centre designation were more likely to provide a neurology consultation. Better TIA preventive care could be achieved through increased inpatient admissions, or through enhanced neurology and other care resources in the ED and during follow-up care.
Identifiants
pubmed: 31909209
doi: 10.1136/bmjoq-2019-000641
pii: bmjoq-2019-000641
pmc: PMC6937041
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e000641Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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