Jia Huanguang, Ried L Douglas, Wang Xinping, Damush Teresa M, Young Linda J, Cameon Randi H, Williams Linda S
Department of Veterans Affairs (VA) Stroke Quality Enhancement Research Initiative (QUERI) and VA Rehabilitation Outcomes Research Center Research Enhancement Award Program, Gainesville, FL, USA.
J Rehabil Res Dev. 2008;45(7):1027-35. doi: 10.1682/jrrd.2007.06.0090.
This study compared patterns of poststroke depression (PSD) detection among veterans with acute stroke in eight U.S. geographic regions. Department of Veterans Affairs (VA) medical and pharmacy data as well as Medicare data were used. International Classification of Diseases-9th Revision depression codes and antidepressant medication dispensing were applied to define patients' PSD status 12 months poststroke. Logistic regression models were fit to compare VA PSD diagnosis and overall PSD detection between the regions. The use of VA medical data alone may underestimate the rate of PSD. Geographic variation in PSD detection depended on the data used. If VA medical data alone were used, we found no significant variation. If VA medical data were used along with Medicare and VA pharmacy data, we observed a significant variation in overall PSD detection across the regions after adjusting for potential risk factors. VA clinicians and policy makers need to consider enrollees' use of services outside the system when conducting program evaluation. Future research on PSD among veteran patients should use VA medical data in combination with Medicare and VA pharmacy data to obtain a comprehensive understanding of patients' PSD.
本研究比较了美国八个地理区域急性中风退伍军人中中风后抑郁症（PSD）的检测模式。使用了退伍军人事务部（VA）的医疗和药房数据以及医疗保险数据。应用国际疾病分类第九版抑郁症编码和抗抑郁药物配药来定义患者中风后12个月的PSD状态。采用逻辑回归模型比较各区域之间的VA PSD诊断和总体PSD检测情况。仅使用VA医疗数据可能会低估PSD的发生率。PSD检测的地理差异取决于所使用的数据。如果仅使用VA医疗数据，我们未发现显著差异。如果将VA医疗数据与医疗保险和VA药房数据一起使用，在调整潜在风险因素后，我们观察到各区域之间总体PSD检测存在显著差异。VA临床医生和政策制定者在进行项目评估时需要考虑参保人在系统外的服务使用情况。未来关于退伍军人患者PSD的研究应将VA医疗数据与医疗保险和VA药房数据结合使用，以全面了解患者的PSD情况。
