Quality enhancement research initiative in stroke - Prevention, treatment,and rehabilitation

Stroke is the third leading cause of death and a leading cause of adult dis ability in the United States. Both within and outside of the Veterans Healt h Administration (VHA), the lack of a systematic approach to stroke prevent ion 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 eases (eg, systematic anticoagulation management), the VHA is perceiv ed as a leader in applied research; therefore, a systematic national policy for implementing these clinics may significantly reduce stroke rates. In o ther areas (eg, carotid endarterectomy), databases exist that would help ad vance quality and outcomes, but short-term studies are necessary to establi sh their utility. To promote strategic improvement in prevention, treatment, and rehabilitati on for veterans who may be at risk or have had a stroke, specific objective s are proposed to (1) identify best practices for the effective delivery of longterm anticoagulation and enhance veterans' access to these services, ( 2) develop risk-adjusted models for the surgical preventive procedure carot id 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 ri sk adjustment and the location of outcomes so as to facilitate the implemen tation of best rehabilitation practices.