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Using VA Medical Data Alone May Underestimate Post-Stroke Depression and Geographic Variation in this Condition


Depression is common after stroke, with most estimates indicating that post-stroke depression (PSD) occurs among approximately 25-40% of stroke survivors. PSD impedes patients’ functional recovery and quality of life, and is associated with increased morbidity, mortality, and healthcare use, but it is often under-diagnosed and under-treated. This study compared geographic variation in PSD detection among 5,593 veterans diagnosed with acute stroke in FY01 across eight regions (e.g., Mideast, Plains, and Southwest). Using administrative data from VA and Medicare, investigators assessed PSD at 12-months post-stroke, in addition to sociodemographic variables and clinical and disease severity (e.g., ischemic stroke vs. all others).

Findings showed that when VA medical data alone were used, investigators found no significant geographic variation. But when VA medical data were used along with Medicare and VA pharmacy data, significant geographic variation (nearly double – 39.1% vs. 20.0%) in the overall detection of PSD was observed. This suggests that to gain a comprehensive view of PSD detection in VA patients, investigators must evaluate non-VA data sources because 70% of VA stroke patients were multiple health program users.

Jia H, Ried L, Wang X, Damush T, Young L, Cameon R, Williams L. Geographic variation in post-stroke depression among veterans with acute stroke. Journal of Rehabilitation Research and Development 2008;45(7):1027-36.

This study was funded through VA/HSR&D’s Stroke Quality Enhancement Research Initiative (Stroke-QUERI). All authors are part of Stroke-QUERI.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.