Singh Steven N
Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Am J Manag Care. 2009 Jun;15(6 Suppl):S185-92.
Transient ischemic attack (TIA) and stroke are commonly occurring cerebrovascular events that require prompt and appropriate treatment to reduce the risk of secondary stroke. The US Department of Veterans Affairs (VA) and the Department of Defense constitute 2 large medical systems treating military personnel, both active and retired, as well as many of their dependents. In the area of stroke and TIA management, the VA in particular has instituted far-reaching measures, including those to ensure adherence to clinical treatment guidelines shown to produce optimal outcomes in stroke. The result of these measures has been that VA patients experience lower morbidity and mortality risk, as well as lower rates of stroke-related rehospitalization, than comparable patients treated through Medicare and Medicaid and in university hospitals. These successes in part may be an advantage derived from a relatively closed system with sufficient administrative discipline to maintain clinical guidelines treatment standards. It may also be the case that continuity of care in these systems produces better outcomes than more fragmentary treatment that may be experienced in the civilian realm. In addition, the VA system avoids incentivizing physicians for performing medical services, and instead incentivizes quality of care, which may provide a further advantage for patients treated within that system.
短暂性脑缺血发作（TIA）和中风是常见的脑血管事件，需要及时且恰当的治疗以降低继发性中风的风险。美国退伍军人事务部（VA）和国防部构成了两个大型医疗系统，为现役和退役军事人员及其许多家属提供治疗。在中风和TIA管理领域，VA尤其采取了意义深远的措施，包括那些确保遵循已证明能在中风治疗中产生最佳效果的临床治疗指南的措施。这些措施的结果是，与通过医疗保险和医疗补助计划治疗的患者以及大学医院的可比患者相比，VA患者的发病和死亡风险更低，与中风相关的再次住院率也更低。这些成功部分可能源于一个相对封闭的系统所具有的优势，该系统有足够的行政纪律来维持临床指南治疗标准。也有可能是这些系统中的连续护理比民间领域可能经历的更零散的治疗产生了更好的结果。此外，VA系统不鼓励医生进行医疗服务，而是鼓励医疗质量，这可能为在该系统接受治疗的患者提供进一步的优势。
