scholarly journals Estimating and Reporting on the Quality of Inpatient Stroke Care by Veterans Health Administration Medical Centers

2012 ◽  
Vol 5 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Greg Arling ◽  
Mathew Reeves ◽  
Joseph Ross ◽  
Linda S. Williams ◽  
Salomeh Keyhani ◽  
...  
Keyword(s):  
Stroke Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Administration Medical ◽  
Medical Centers

Denominator Doesn’t Matter: Standardizing Healthcare-Associated Infection Rates by Bed Days or Device Days

2015 ◽  
Vol 36 (6) ◽  
pp. 710-716 ◽  
Author(s):  
Molly J. Horstman ◽  
Yu-Fang Li ◽  
Peter L. Almenoff ◽  
Ron W. Freyberg ◽  
Barbara W. Trautner
Keyword(s):  
Veterans Health Administration ◽  
Strongly Correlated ◽  
Veterans Health ◽  
Health Administration ◽  
Infection Rates ◽  
Healthcare Associated Infection ◽  
Administration Medical ◽  
Medical Centers ◽  
Bed Days ◽  
Healthcare Associated

OBJECTIVETo examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominatorDESIGNRetrospective survey from October 2010 to July 2013SETTINGVeterans Health Administration medical centers providing acute medical and surgical carePATIENTSPatients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infectionsMETHODSWe examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance.RESULTSA total of 7.9 million bed days were included. From 2011 to 2013, CAUTI decreased whether measured by device days (2.32 to 1.64, P=.001) or bed days (4.21 to 3.02, P=.006). CLABSI decreased when measured by bed days (1.67 to 1.19, P=.04). VAP rates and device utilization ratios for CAUTI, CLABSI, and VAP were not statistically different across time. Infection rates calculated with device days were strongly correlated with infection rates calculated with bed days (r=0.79–0.94, P<.001). Hospital relative performance measured by ordered rank was also strongly correlated for both denominators (r=0.82–0.96, P<.001).CONCLUSIONSThese findings suggest that device days and bed days are equally effective adjustment metrics for comparing healthcare-associated infection rates between hospitals in the setting of stable device utilization.Infect Control Hosp Epidemiol 2015;00(0): 1–7

Abstract TP402: Stroke Nurse Coordinators: Role in Transient Ischemic Attack (TIA) Care in the National Veterans Health Administration

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Teresa M Damush ◽  
Edward J Miech ◽  
Michael Phipps ◽  
Jason Sico ◽  
Greg Arling ◽  
...  
Keyword(s):  
Care Coordination ◽  
Stroke Care ◽  
Veterans Health Administration ◽  
Quality Data ◽  
Minor Stroke ◽  
Veterans Health ◽  
Health Administration ◽  
Nurse Coordinator ◽  
Outpatient Settings

Background: With the purpose of identifying gaps as well as best practices in guideline-concordant TIA/minor stroke care in the Veterans Health Administration (VHA) system, we sought to elucidate the perceived challenges and facilitators of TIA care across clinical specialties and across settings of care. Methods: We conducted a prospective, formative evaluation in 14 VHA hospitals across the US. We conducted 70 semi-structured interviews with front-line clinicians, leadership and quality managers. Interviews were audiorecorded, transcribed, and double coded in Nvivo 10 software using an emergent codebook. We analyzed the reported challenges and facilitators of TIA guideline care. Results: Six of the fourteen sites reported the existence of a Stroke Nurse Coordinator to track the quality of stroke care and to minimize the gaps in services across inpatient and outpatient settings. Of the six, only one site had a defined algorithm for TIA care services specifically for and separate from their stroke protocols. A lack of care coordination for TIA patients across services and across the inpatient and outpatient settings were major reported challenges. Sites without a stroke coordinator often reported a lack of staff to reduce this service gap. Some provided outpatient follow-up as well as risk factor management at the inpatient bedside for all admitted TIA patients and this appeared to facilitate TIA care. Educating facility staff for stroke care was a common responsibility, but few stated they provided TIA-specific staff education. Stroke/TIA quality data collection was often performed by the Stroke Nurse Coordinator; however the data feedback process varied widely across facilities from none to a stroke team, and by schedule from weekly or, quarterly to occasionally. It is unclear how the Stroke Nurse Coordinator interacted with the neurology service from these data, but the six sites with a Stroke Nurse Coordinator had much lower rates of consulting the Neurology service. Conclusions: Extending the role of the local Stroke Coordinator to include specifying a TIA protocol, assisting care coordination for patients with TIA, tracking and feeding quality data back to local providers may improve the quality of TIA care. SDP # 12-178.

Improving Knowledge and Information Sharing to Promote Best Practices in Stroke Care

2013 ◽  
Vol 2 (1) ◽  
pp. 11-25 ◽  
Author(s):  
Elizabeth Sternke ◽  
Nicholas Burrus ◽  
Virginia Daggett ◽  
Laurie Plue ◽  
Katherine Carlson ◽  
...  
Keyword(s):  
Best Practices ◽  
Qualitative Interviews ◽  
Stroke Care ◽  
Care Quality ◽  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Geographically Dispersed ◽  
User Friendly

Despite many advances in stroke care treatment, there is substantial room for improvement in quality of care for stroke patients. In an attempt to disseminate up-to-date quality information and evidence-based best practices of stroke care, the Veterans Health Administration (VHA)and the VHA Stroke QUERI implemented an innovative web-based toolkit tailored for providers and program planners interested in improving stroke care quality. This study evaluated the VA Stroke QUERI Toolkit to determine its most useful aspects and those that require improvement. In-depth qualitative interviews (n = 48) were conducted with a geographically dispersed sample of clinicians and program planners throughout the VHA system. Findings suggest the Stroke QUERI toolkit was perceived as an effective, efficient and user-friendly site but knowledge of the toolkit continues to be initiated and shared mainly through individuals and small groups. To achieve greater impact a comprehensive set of strategies designed to encourage broader uptake is required.

Sign in / Sign up

Export Citation Format

Share Document