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Published on: May 22, 2019
Geographic variation in poststroke depression among veterans with acute stroke
Huanguang Jia1, L Douglas Ried, Xinping Wang
1Department of Veterans Affairs (VA) Stroke Quality Enhancement Research Initiative (QUERI) and VA Rehabilitation Outcomes Research Center Research Enhancement Award Program, Gainesville, FL, USA. Huanguang.Jia@med.va.gov
Detecting poststroke depression (PSD) in veterans requires integrating Department of Veterans Affairs (VA) medical, pharmacy, and Medicare data. Combining data sources reveals significant geographic variations in PSD detection rates among veterans.
Area of Science:
- Health Services Research
- Psychiatry
- Gerontology
Background:
- Poststroke depression (PSD) is a common complication affecting patient recovery and quality of life.
- Accurate detection of PSD is crucial for timely intervention and management among veteran populations.
- Existing data sources may not fully capture the prevalence and patterns of PSD detection.
Purpose of the Study:
- To compare poststroke depression detection patterns among U.S. veterans across eight geographic regions.
- To evaluate the impact of different data sources (VA medical, VA pharmacy, Medicare) on PSD detection rates.
- To identify geographic variations in PSD detection and inform healthcare policy.
Main Methods:
- Utilized Department of Veterans Affairs (VA) medical and pharmacy data, alongside Medicare data.
- Defined poststroke depression (PSD) status using International Classification of Diseases-9th Revision (ICD-9) codes and antidepressant medication dispensing.
- Employed logistic regression models to compare PSD diagnosis and detection rates across regions, adjusting for risk factors.
Main Results:
- Using VA medical data alone underestimated PSD rates and showed no significant geographic variation.
- Integrating VA medical, pharmacy, and Medicare data revealed significant geographic variations in overall PSD detection.
- The choice of data significantly influenced the observed patterns of PSD detection.
Conclusions:
- Relying solely on VA medical data can lead to an underestimation of poststroke depression (PSD) prevalence.
- Significant geographic variations in PSD detection exist among veterans, contingent upon the data utilized.
- Comprehensive assessment of PSD in veterans necessitates combining VA medical data with external data sources like Medicare and VA pharmacy records.
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