Jia Huanguang, Phipps Michael, Bravata Dawn, Castro Jaime, Li Xinli, Ordin Diana, Myers Jennifer, Vogel W Bruce, Williams Linda, Chumbler Neale
US Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Rehabilitation Outcomes Research Center, Gainesville, FL, USA.
Int J Stroke. 2015 Jan;10(1):67-72. doi: 10.1111/j.1747-4949.2012.00861.x. Epub 2012 Sep 13.
Stroke mortality has been found to be much higher among residents in the stroke belt region than in the rest of United States, but it is not known whether differences exist in the quality of stroke care provided in Department of Veterans Affairs medical centers in states inside and outside this region.
We compared mortality and inpatient stroke care quality between Veterans Affairs medical centers inside and outside the stroke belt region.
Study patients were veterans hospitalized for ischemic stroke at 129 Veterans Affairs medical centers. Inpatient stroke care quality was assessed by 14 quality indicators. Multivariable logistic regression models were fit to examine differences in quality between facilities inside and outside the stroke belt, adjusting for patient characteristics and Veterans Affairs medical centers clustering effect.
Among the 3909 patients, 28·1% received inpatient ischemic stroke care in 28 stroke belt Veterans Affairs medical centers, and 71·9% obtained care in 101 non-stroke belt Veterans Affairs medical centers. Patients cared for in stroke belt Veterans Affairs medical centers were more likely to be younger, Black, married, have a higher stroke severity, and less likely to be ambulatory pre-stroke. We found no statistically significant differences in short- and long-term post-admission mortality and inpatient care quality indicators between the patients cared for in stroke belt and non-stroke belt Veterans Affairs medical centers after risk adjustment.
These data suggest that a stroke belt does not exist within the Veterans Affairs health care system in terms of either post-admission mortality or inpatient care quality.
研究发现，卒中带地区居民的卒中死亡率远高于美国其他地区，但尚不清楚该地区内外各州的退伍军人事务部医疗中心所提供的卒中护理质量是否存在差异。
我们比较了卒中带地区内外退伍军人事务部医疗中心的死亡率和住院卒中护理质量。
研究患者为在129家退伍军人事务部医疗中心因缺血性卒中住院的退伍军人。通过14项质量指标评估住院卒中护理质量。采用多变量逻辑回归模型，在调整患者特征和退伍军人事务部医疗中心聚类效应后，检验卒中带内外医疗机构在质量上的差异。
在3909例患者中，28.1%在28家卒中带退伍军人事务部医疗中心接受了缺血性卒中住院治疗，71.9%在101家非卒中带退伍军人事务部医疗中心接受了治疗。在卒中带退伍军人事务部医疗中心接受治疗的患者更可能较年轻、为黑人、已婚，卒中严重程度更高，且卒中前能够行走的可能性更小。在进行风险调整后，我们发现卒中带和非卒中带退伍军人事务部医疗中心的患者在入院后短期和长期死亡率以及住院护理质量指标方面没有统计学上的显著差异。
这些数据表明，就入院后死亡率或住院护理质量而言，退伍军人事务部医疗保健系统内不存在卒中带。
