VA research in action
Spreading best practices in stroke care
VA providers implemented best practices in stroke care based on research from the Richard L. Roudebush VA Medical Center in Indianapolis. Following VA's Acute Ischemic Stroke Directive, VA began an intervention to improve stroke care in 2012. The intervention included a face-to-face collaborative training session for stroke team members, followed by six months of on-site support by improvement experts. The training focused on screening for two major stroke indicators: deep vein thrombosis (blood clots forming in deep veins) and dysphagia (difficulty swallowing).
The AIS Directive resulted in a major reorganization of stroke care in VA and the beginning of ongoing stroke quality measurement. This led to improvements in the rate of thrombolysis—the breakdown of clots formed in blood vessels, using medication—among affected Veterans, from 8 percent in 2007 to 69 percent in 2017. The effort involved the drug tPA, or tissue plasminogen activator.
The AIS Directive was further supported through a VA national stroke quality-improvement group, which implemented stroke-care best practices for over 5,600 Veterans across 86 VA facilities. This group, now known as the Precision Monitoring (PRIS-M) QUERI, continues to do work to improve care for Veterans with stroke. Their work includes projects to evaluate telehealth care for stroke patients and a monthly conference call to share stroke-care quality data.
Principal investigator: Linda Williams, M.D.; Richard L. Roudebush VA Medical Center
Williams L, Daggett V, Slaven JE, Yu Z, Sager D, Myers J, Plue L, Woodward-Hagg H, Damush TM. A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators. BMJ Qual Saf. 2016 Apr;25(4):257-64.
Treatment of Acute Ischemic Stroke (AIS). VHA Directive 2011-038. Department of Veterans Affairs. Veterans Health Administration. 2 November 2011.
Phipps M, Fahner F, Sager D, Coffing J, Maryfield B, Williams LS. Validation of stroke meaningful use measures in a national EHR system. J Gen Internal Med. 2016;21(Suppl 1):46-52.