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Change has come to the Stroke QUERI in the form of a recent reorganization of our Research and Clinical Coordinators. In December 2006, Dr. Pamela Duncan accepted an endowed position at Duke University where she will continue her research in stroke rehabilitation, outcomes, and policy. Her leadership and infectious energy were fundamental to the successful launch of the Stroke QUERI in April, 2004, and to our ongoing work to improve stroke care in the VA. We are pleased to say that although Dr. Duncan has stepped down as Research Coordinator of the QUERI, she will serve on our Executive Committee and continue to collaborate on key stroke projects.
Dr. Linda Williams, former Stroke QUERI Clinical Coordinator, has accepted the role of Research Coordinator. Her in-depth involvement in the QUERI Operations Committee, the Implementation Core, and her role as leader of one of the QUERI workgroups will ensure that the major projects and strategic plans of the QUERI will continue uninterrupted. Dr. Williams’ role as Chief of Neurology at the Roudebush VAMC in Indianapolis will further help to link the Stroke QUERI to front-line clinicians and managers as we work to impact the care of veterans with stroke. This transition will also link the QUERI more closely to the Center for Implementing Evidence-Based Practice in Indianapolis
(Dr. Brad Doebbeling, Director), where Dr. Williams and Dr. Teresa Damush, Stroke QUERI Implementation Research Coordinator, are Senior Investigators. Dr. Dawn Bravata, internist and stroke researcher from the VA Connecticut Healthcare System in New Haven and Yale University, has assumed the position of Stroke QUERI Clinical Coordinator (page 2). Dr. Bravata brings substantial expertise in stroke care quality assessment, and stroke risk factor management. In addition to becoming the Clinical Coordinator, she will lead our QUERI Workgroup focusing on guideline implementation. She will join the Center for Implementing Evidence-Based Practice in Indianapolis this May.
As the QUERI coordinator positions transition to Indianapolis, Ms. Laurie Plue, former Assistant Implementation Research Coordinator, will take on the role of Stroke QUERI Administrative Coordinator effective March 1, 2007. The QUERI will continue its strong collaboration with the Gainesville VA Rehabilitation Outcomes Research Center (RORC). The major responsibility for our rehabilitation portfolio continues to reside in Gainesville under the leadership of Dr. Neale Chumbler, Dr. Diane Cowper, and Dr. Rebecca Beyth. Ms. Kristen Wing the Stroke QUERI Dissemination Coordinator, as well as many of our investigators will continue to be based at the RORC.
We look forward to the opportunities we have this year to improve stroke care for veterans, including (among others) ongoing projects implementing depression screening post-stroke, improving access to rehabilitation via tele-rehabilitation services, supporting evidence-based decisions for managing atrial fibrillation and other stroke risk factors, and implementing dysphagia screening as a critical inpatient stroke quality of care indicator. Instead of being intimidated by change, we embrace the sentiments of anthropologist Margaret Mead about change: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” The Stroke QUERI is eager to expand our ability to be a force for this type of positive change for stroke care throughout the VA.
Translating Research Results into Clinical Practice
Stroke is one of the major causes of long-term disability among adults, and its prevalence will continue to rise as the population ages. The Veterans Health Administration (VHA) estimates that each year over 15,000 veterans are hospitalized for stroke. Forty percent of these stroke survivors are left with moderate functional impairments and 15 to 30 percent severe disability. Even among those with “mild stroke,” significant residual deficits may limit mobility, increase risk for falls, and limit community reintegration and quality of life. All stroke survivors and their families are hopeful that research will one day help them.
In 1998, Veterans Affairs Health Services Research and Development (HSR&D) Service launched the VA Quality Enhancement Research Initiative (QUERI) with the goal of translating research results into approaches to improve patient care and systems efficiency and to document the effects of these mechanisms on patients and on cost.
The mission of the Stroke Quality Enhancement Research Initiative (QUERI) is to reduce the risk of stroke and to obtain the best possible outcomes for veterans who suffer a stroke.
GOAL 1: Improve compliance with the Department of Veterans Affairs and the Department of Defense clinical practice guidelines for the management of stroke rehabilitation in the primary care setting.
GOAL 2: Improve rehabilitation processes and patient outcomes for VHA stroke survivors.
GOAL 3: Reduce the risk of both primary and secondary stroke by optimizing risk factor management for at-risk patients.
GOAL 4: Reduce the physical, emotional, and social burden of post-stroke depression (PSD).
A long-term goal of the Stroke QUERI is to expand the scope of the research portfolio to include other secondary prevention measures and early phases of stroke care.
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