Future of StrokeCare

 The next step is to make the research available as a launching pad for future projects. According to Williams, at least 20 researchers are using the data to conduct new studies.

One such study that Williams is overseeing is the INSPIRE Stroke Project. QUERI is partnering with VA’s redesign engineers in a randomized trial at 11 VA facilities. Five of the facilities are receiving systems redesign training in stroke teams and ongoing feedback. The remaining six facilities will be receiving data, but no coaching, on their stroke care performance.

Williams and her team will be following these facilities over time to see which indicators improve and how much they improve.

“There are two indicators we’re really focused on — dysphasia screening and DVT prophylaxis by hospital Day Two,” Williams said. There is considerable room for improvement in the former and some room for improvement in the latter.

The partnership between QUERI and OQP can also serve as a framework for future clinical endeavors, explained Deed Ordin, MD, director of special studies at OQP. “This model of having a partnership that involves lead VA clinicians from all over, the measurement office and health services researchers is being developed further in our efforts with lung cancer, which we’ve developed measures for in a similar way.”

The Stroke Project’s success in creating toolkits to help facilities improve performance measures has inspired OQP to create similar kits for other disease conditions. Those include not only diseases being examined by OQP’s Office of Special Studies, but also many high morbidity and high mortality conditions.

“We’re taking the lead now in the development of measures,” Ordin said. “We’re trying to drive improvement and to share our knowledge with others.”

As facilities develop new ways of reaching performance goals, they are sharing those methods with QUERI and OQP, and the new information is being incorporated into the stroke toolkit.

“We’ve found facilities that were doing really well in certain areas. We ask them if we could make it part of the toolkit, and they always say ‘yes’. The toolkit is a living document,” Williams said.

Where work still needs to be done is in post-stroke outpatient care. Looking at veterans with follow-up at VA within six months of a stroke, QUERI found that only 55% had their blood pressure measured and were meeting the recommended goal, less than half had their hemoglobin A1c measured and were meeting the recommended goal, and only 35% had their LDL cholesterol measured and were meeting the recommended goal.

This shows there is much room for improvement in post-stroke care, Williams said. “As healthcare is changing, even in a quite integrated system like VA, there’s not necessarily a strong link between quality on the inpatient side and quality on the outpatient side.”