2022
Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design
Miech EJ, Perkins AJ, Zhang Y, Myers LJ, Sico JJ, Daggy J, Bravata DM. Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design. BMJ Open 2022, 12: e061469. PMID: 35672067, PMCID: PMC9174826, DOI: 10.1136/bmjopen-2022-061469.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCohort StudiesHealth Services ResearchHumansIschemic Attack, TransientStrokeConceptsTransient ischemic attackLogistic regression modelsHealth services researchSet of patientsOverall sample prevalenceObservational cohortLogistic regressionSample prevalenceRecurrent ischemic strokeVeterans Affairs hospitalRegression modelsServices researchIschemic attackRecurrent strokeCause mortalityCombined endpointIschemic strokePatient outcomesDeath outcomesCare outcomesPatientsSecondary analysisPrevalenceOutcomesCohortBlood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack
Arling G, Perkins A, Myers LJ, Sico JJ, Bravata DM. Blood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack. The American Journal Of Medicine 2022, 135: 889-896.e1. PMID: 35292287, DOI: 10.1016/j.amjmed.2022.02.012.Peer-Reviewed Original ResearchMeSH KeywordsAntihypertensive AgentsBlood PressureHumansHypertensionIschemic Attack, TransientRetrospective StudiesStrokeVeteransConceptsSystolic blood pressure trajectoriesTransient ischemic attackSystolic blood pressureBlood pressure trajectoriesBlood pressureAntihypertensive medicationsIschemic attackPressure trajectoriesHigher systolic blood pressureLower systolic blood pressureCox proportional hazards modelBlood pressure reductionBlood pressure controlEmergency department visitsHazard of mortalityProportional hazards modelVA Medical CenterMedication intensificationCause mortalityVascular eventsIschemic strokeRetrospective cohortDepartment visitsHypertension managementIndex event
2021
Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence
Levine DA, Perkins AJ, Sico JJ, Myers LJ, Phipps MS, Zhang Y, Bravata DM. Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence. Stroke 2021, 52: 2371-2378. PMID: 34039034, PMCID: PMC8238890, DOI: 10.1161/strokeaha.120.031721.Peer-Reviewed Original ResearchConceptsIschemic stroke incidenceStroke incidenceHospital factorsPhysician staffingTIA patientsHypertension controlProcess measuresModerate potency statinTransient ischemic attackDays of dischargeEmergency department dischargeVeterans Affairs hospitalEligible patientsIschemic attackStatin useAntithrombotic useEmergency departmentEmergency physiciansInpatient unitDay 2HospitalPatient volumeFiscal year 2015PatientsIncidenceBenefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack
Brown DL, Levine DA, Albright K, Kapral MK, Leung LY, Reeves MJ, Sico J, Strong B, Whiteley WN, Council O. Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke 2021, 52: e468-e479. PMID: 34024115, DOI: 10.1161/str.0000000000000377.Peer-Reviewed Original ResearchConceptsDual antiplatelet therapySingle antiplatelet therapyTransient ischemic attackHigh-risk transient ischemic attackIschemic stroke preventionRecurrent ischemic strokeIschemic attackIschemic strokeAntiplatelet therapyStroke preventionMajor bleedingRelative riskTreatment durationAmerican Heart Association/American Stroke AssociationSystematic reviewSecondary ischemic stroke preventionSecondary stroke preventionPrevention of strokeUnadjusted relative riskAmerican Stroke AssociationSecondary ischemic strokeDuration of treatmentLonger duration treatmentShort-duration trialsRecurrent strokeDeintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack
Dearborn-Tomazos JL, Hu X, Bravata DM, Phadke MA, Baye FM, Myers LJ, Concato J, Zillich AJ, Reeves MJ, Sico JJ. Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke 2021, 52: 2521-2529. PMID: 34015937, DOI: 10.1161/strokeaha.120.030089.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIschemic Attack, TransientIschemic StrokeMaleMiddle AgedMortalityTreatment OutcomeVeterans Health ServicesConceptsTransient ischemic attackIschemic strokeIschemic attackHospital dischargeHospital admissionHigh mortalityVeterans Health Administration facilitiesHigh-potency statinsUnderutilization of statinsHigh potencyStatin doseStatin medicationBaseline characteristicsMost patientsPrescribed statinsStatin treatmentPharmacy filesStatin potencyAtherosclerotic originUS veteransPractice guidelinesStudy populationHigher oddsPatientsStatins
2020
Implementation Evaluation of a Complex Intervention to Improve Timeliness of Care for Veterans with Transient Ischemic Attack
Damush T, Miech E, Rattray N, Homoya B, Penney L, Cheatham A, Baird S, Myers J, Austin C, Myers L, Perkins A, Zhang Y, Giacherio B, Kumar M, Murphy L, Sico J, Bravata D. Implementation Evaluation of a Complex Intervention to Improve Timeliness of Care for Veterans with Transient Ischemic Attack. Journal Of General Internal Medicine 2020, 36: 322-332. PMID: 33145694, PMCID: PMC7878645, DOI: 10.1007/s11606-020-06100-w.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic attackClinical improvementStepped-wedge implementation trialQI teamsGuideline-concordant careTimeliness of careQuality improvement interventionsVA healthcare systemComplex quality improvement interventionsPrimary outcomeTeam activationImplementation strategiesKey implementation strategiesImplementation trialImprovement interventionsClinical staffComplex interventionsConsolidated FrameworkQI programQI planExternal facilitationImplementation researchHealthcare systemPoint improvementAssessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack
Bravata DM, Myers LJ, Perkins AJ, Zhang Y, Miech EJ, Rattray NA, Penney LS, Levine D, Sico JJ, Cheng EM, Damush TM. Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack. JAMA Network Open 2020, 3: e2015920. PMID: 32897372, PMCID: PMC7489850, DOI: 10.1001/jamanetworkopen.2020.15920.Peer-Reviewed Original ResearchConceptsTransient ischemic attackQuality of careIschemic attackElectronic health record toolsRecurrent vascular eventsDiverse medical centersGuideline-recommended processesQuality improvement interventionsProportion of veteransHealth care systemImplementation periodIntervention associationsQI supportVascular eventsMost patientsPrimary outcomeMean ageCare existIntervention periodSymptom interventionMedical CenterQI interventionsMAIN OUTCOMEHigh riskTimely management
2019
Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration
Arling G, Sico JJ, Reeves MJ, Myers L, Baye F, Bravata DM. Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration. BMJ Open Quality 2019, 8: e000641. PMID: 31909209, PMCID: PMC6937041, DOI: 10.1136/bmjoq-2019-000641.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAdultAgedAged, 80 and overEmergency Service, HospitalFemaleHumansIschemic Attack, TransientMaleMiddle AgedNeurologyPatient AdmissionQuality of Health CareReferral and ConsultationRetrospective StudiesStrokeTime FactorsUnited StatesUnited States Department of Veterans AffairsVeteransConceptsTransient ischemic attackCharlson Comorbidity IndexVeterans Health AdministrationHigher Charlson comorbidity indexUS Veterans Health AdministrationInpatient admissionsNeurological consultationNeurology consultationEmergency departmentIschemic attackPreventive careHealth AdministrationCare qualitySpeech deficitsHigher CCI scoresModerate potency statinRecurrent vascular eventsStroke center designationHistory of dementiaPreventive care qualityAntithrombotic medicationComorbidity indexCCI scoreED visitsRetrospective cohortThe protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods
Bravata D, Myers L, Homoya B, Miech E, Rattray N, Perkins A, Zhang Y, Ferguson J, Myers J, Cheatham A, Murphy L, Giacherio B, Kumar M, Cheng E, Levine D, Sico J, Ward M, Damush T. The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods. BMC Neurology 2019, 19: 294. PMID: 31747879, PMCID: PMC6865042, DOI: 10.1186/s12883-019-1517-x.Peer-Reviewed Original ResearchMeSH KeywordsClinical ProtocolsDelivery of Health CareEarly DiagnosisHumansIschemic Attack, TransientProgram EvaluationQuality ImprovementVeteransConceptsElectronic health record toolsRecurrent vascular eventsTime-sensitive careProportion of patientsTransient neurological symptomsStepped-wedge trialProcess of careQuality improvement interventionsMulti-component interventionQuality Improvement ProgramElectronic quality measuresQI supportTIA careVascular eventsNeurological symptomsLearning healthcare systemAttack patientsClinical conditionsMedical CenterEffectiveness outcomesHigh riskTimely managementClinical protocolsImprovement interventionsClinical settingPolysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack
Koo BB, Sico JJ, Myers LJ, Perkins AJ, Levine D, Miech EJ, Damush TM, Rattray N, Homoya B, Ferguson J, Myers J, Zhang Y, Bravata DM. Polysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack. Cerebrovascular Diseases 2019, 48: 179-183. PMID: 31722335, DOI: 10.1159/000504406.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaComorbidityFemaleHealth Services AccessibilityHealth StatusHumansIschemic Attack, TransientMaleMiddle AgedPolysomnographyPractice Guidelines as TopicPractice Patterns, Physicians'Predictive Value of TestsPrognosisRisk FactorsSleep Apnea, ObstructiveStrokeTime FactorsUnited StatesUnited States Department of Veterans AffairsVeterans HealthConceptsTransient ischemic attackAcute ischemic strokeObstructive sleep apneaVeterans Administration Medical CenterTreatment of OSAIschemic strokeIschemic attackClinical dataExact testVA Corporate Data WarehouseCerebrovascular risk factorsMixed-effects logistic regressionFisher's exact testCorporate Data WarehouseEffects logistic regressionTwo-sample t-testAcute strokeClinical characteristicsHospital dischargeHeart failureSleep apneaFunctional outcomeRisk factorsUS veteransRecent guidelinesProcesses of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke
Bravata DM, Myers LJ, Reeves M, Cheng EM, Baye F, Ofner S, Miech EJ, Damush T, Sico JJ, Zillich A, Phipps M, Williams LS, Chaturvedi S, Johanning J, Yu Z, Perkins AJ, Zhang Y, Arling G. Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke. JAMA Network Open 2019, 2: e196716. PMID: 31268543, PMCID: PMC6613337, DOI: 10.1001/jamanetworkopen.2019.6716.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaEligibility DeterminationFemaleHumansIschemic Attack, TransientLong Term Adverse EffectsMaleMiddle AgedMortalityOutcome and Process Assessment, Health CarePatient Care ManagementPrognosisRecurrenceRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeUnited StatesVeterans Health ServicesConceptsTransient ischemic attackRecurrent ischemic strokeIschemic strokeRisk of deathRecurrent strokeProcess of careLower oddsMedication intensificationIschemic attackAtrial fibrillationVeterans Affairs emergency departmentAntihypertensive medication classesMortality 1 yearManagement of patientsMultivariable logistic regressionRisk of mortalityMultiple comparisonsCarotid artery imagingCause mortalityLipid managementMedication classesStatin medicationStatin therapyCohort studyStroke risk
2018
Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack
Homoya BJ, Damush TM, Sico JJ, Miech EJ, Arling GW, Myers LJ, Ferguson JB, Phipps MS, Cheng EM, Bravata DM. Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack. Journal Of General Internal Medicine 2018, 34: 1715-1723. PMID: 30484102, PMCID: PMC6712185, DOI: 10.1007/s11606-018-4735-9.Peer-Reviewed Original ResearchConceptsTransient ischemic attackVA Medical CenterTIA patientsChart review dataAdmission ratesTIA admissionsTIA careABCD2 scoreIschemic attackChart reviewAdministrative dataSubsequent vascular eventsSecondary prevention strategiesSubset of patientsQuality improvement interventionsHigher admission ratesQuality of careKey ResultsProvidersTimely workupVascular eventsEmergency departmentInpatient settingMedical CenterHigh riskPatientsDiagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease
Bravata DM, Sico J, Fragoso C, Miech EJ, Matthias MS, Lampert R, Williams LS, Concato J, Ivan CS, Fleck JD, Tobias L, Austin C, Ferguson J, Radulescu R, Iannone L, Ofner S, Taylor S, Qin L, Won C, Yaggi HK. Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease. Journal Of The American Heart Association 2018, 7: e008841. PMID: 30369321, PMCID: PMC6201384, DOI: 10.1161/jaha.118.008841.Peer-Reviewed Original ResearchConceptsContinuous positive airway pressure usePositive airway pressure useTransient ischemic attackRankin Scale scoreIschemic stroke/transient ischemic attackStroke/transient ischemic attackBackground Obstructive sleep apneaHealth Stroke ScaleIschemic attackScale scoreStroke ScaleIschemic strokeTreat analysisSleep apneaAcute ischemic stroke/transient ischemic attackHealth Stroke Scale scoreNational InstituteContinuous positive airway pressureModified Rankin Scale scoreNeurological functioningNeurological symptom severityRecent ischemic strokeStroke Scale scoreAcute cerebrovascular diseaseAcute ischemic strokeQuality of Care for Veterans With Transient Ischemic Attack and Minor Stroke
Bravata DM, Myers LJ, Arling G, Miech EJ, Damush T, Sico JJ, Phipps MS, Zillich AJ, Yu Z, Reeves M, Williams LS, Johanning J, Chaturvedi S, Baye F, Ofner S, Austin C, Ferguson J, Graham GD, Rhude R, Kessler CS, Higgins DS, Cheng E. Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke. JAMA Neurology 2018, 75: 419-427. PMID: 29404578, PMCID: PMC5885264, DOI: 10.1001/jamaneurol.2017.4648.Peer-Reviewed Original ResearchConceptsTransient ischemic attackMinor strokeEmergency departmentElements of careDay 2Ischemic attackDay 7Federal fiscal year 2014Intensive care unit stayDeep vein thrombosis prophylaxisVeterans Health Administration systemCare qualityReceipt of thrombolysisRecurrent vascular eventsStroke care qualityVHA emergency departmentGuideline-concordant careLength of stayGuideline-recommended processesProcess of careHealth Administration systemQuality of careHemoglobin A1c measurementsElectronic quality measuresHealth care system
2017
Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction
Bravata DM, Daggy J, Brosch J, Sico JJ, Baye F, Myers LJ, Roumie CL, Cheng E, Coffing J, Arling G. Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction. Stroke 2017, 49: 296-303. PMID: 29284738, DOI: 10.1161/strokeaha.117.017142.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaFemaleHumansHyperlipidemiasHypertensionIschemic Attack, TransientMaleMiddle AgedMyocardial InfarctionRisk FactorsStrokeConceptsAcute myocardial infarctionRisk factor controlIncident ischemic strokeBlood pressure controlIschemic stroke patientsIschemic strokeStroke patientsGlycemic controlAMI patientsMyocardial infarctionPressure controlIncident acute myocardial infarctionChronic obstructive pulmonary diseaseVascular risk factor controlFacility-level covariatesTransient ischemic attackAcute ischemic strokeCongestive heart failureObstructive pulmonary diseaseVeterans Health AdministrationFactor controlFacility covariatesIschemic attackHypertension controlStroke preventionBarriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration
Damush TM, Miech EJ, Sico JJ, Phipps MS, Arling G, Ferguson J, Austin C, Myers L, Baye F, Luckhurst C, Keating AB, Moran E, Bravata DM. Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration. Neurology 2017, 89: 2422-2430. PMID: 29117959, PMCID: PMC5729798, DOI: 10.1212/wnl.0000000000004739.Peer-Reviewed Original ResearchMeSH KeywordsAftercareAttitude of Health PersonnelContinuity of Patient CareCross-Sectional StudiesEmergency MedicineGuideline AdherenceHealth Services AccessibilityHospitalistsHumansIschemic Attack, TransientLeadershipMedical Staff, HospitalNeuroimagingNeurologistsNursesOphthalmologistsPhysiciansPractice Guidelines as TopicQualitative ResearchQuality of Health CareRadiologistsSurgeonsUnited StatesUnited States Department of Veterans AffairsConceptsTIA careVeterans Health AdministrationNurse coordinatorClinical staffNational Veterans Health AdministrationInadequate staff educationSystem-level facilitatorsGuideline-based careVeterans Healthcare AdministrationHealth care facilitiesSystem-level factorsTIA patientsVHA hospitalsTimely followEmergency departmentEvidence-based practiceCare coordinationInpatient settingObservational studyIndividual patientsContinuous careStaff educationCare facilitiesHealth AdministrationPatient careDevelopment and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke
Bravata DM, Myers LJ, Cheng E, Reeves M, Baye F, Yu Z, Damush T, Miech EJ, Sico J, Phipps M, Zillich A, Johanning J, Chaturvedi S, Austin C, Ferguson J, Maryfield B, Snow K, Ofner S, Graham G, Rhude R, Williams LS, Arling G. Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003157. PMID: 28912200, DOI: 10.1161/circoutcomes.116.003157.Peer-Reviewed Original ResearchConceptsTransient ischemic attackElectronic quality measuresMinor ischemic strokeProportion of patientsIschemic attackIschemic strokeEHR dataDeep vein thrombosis prophylaxisVeterans Health Administration facilitiesCoronary risk assessmentInternational normalized ratioElectronic health record dataIschemic stroke careHealth record dataQuality of careSubstance abuse referralAntihypertensive classesMedication intensificationThrombosis prophylaxisLipid managementChart reviewStroke careAtrial fibrillationNeurology consultationNormalized ratioDevelopment, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea
Sico JJ, Yaggi HK, Ofner S, Concato J, Austin C, Ferguson J, Qin L, Tobias L, Taylor S, Fragoso C, McLain V, Williams LS, Bravata DM. Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea. Journal Of Stroke And Cerebrovascular Diseases 2017, 26: 1745-1754. PMID: 28416405, PMCID: PMC6006998, DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.042.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overArea Under CurveBrain IschemiaDecision Support TechniquesFemaleHumansIschemic Attack, TransientMaleMiddle AgedPolysomnographyPredictive Value of TestsPrevalencePrognosisReproducibility of ResultsRisk AssessmentRisk FactorsROC CurveSleepSleep Apnea, ObstructiveStrokeSurveys and QuestionnairesTime FactorsUnited StatesConceptsObstructive sleep apneaTransient ischemic attackHigh negative predictive valueEpworth Sleepiness ScaleNegative predictive valueIschemic strokeSleep apneaPresence of OSASleep InventoryPredictive valueSleep Apnea Clinical ScoreValidation study populationHigh blood pressureBody mass indexIschemic attackObserved apneaBerlin questionnaireStroke severityBlood pressureOvernight polysomnographyMass indexRandomized trialsClinical scoresSleep QuestionnaireMedical history
2016
Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?
Chaturvedi S, Ofner S, Baye F, Myers LJ, Phipps M, Sico JJ, Damush T, Miech E, Reeves M, Johanning J, Williams LS, Arling G, Cheng E, Yu Z, Bravata D. Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke? Neurology 2016, 88: 237-244. PMID: 27927939, PMCID: PMC5272790, DOI: 10.1212/wnl.0000000000003503.Peer-Reviewed Original ResearchConceptsTIA/minor strokeDays of presentationMinor strokeDiffusion-weighted imagingPrevious guidelinesHospital complexityCoronary artery diseaseMinor stroke patientsVeterans Affairs hospitalPreferred imaging modalityUse of MRISubset of hospitalsFacility-level variablesPerformance of MRINational Health SystemPrior strokeSymptom durationChart abstractionArtery diseaseBlood pressureHeart failureNeurologic consultationStroke patientsAtrial fibrillationClinical variablesCrossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic
Rattray NA, Sico JJ, Cox LM, Russ AL, Matthias MS, Frankel RM. Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic. The Joint Commission Journal On Quality And Patient Safety 2016, 43: 127-137. PMID: 28334591, DOI: 10.1016/j.jcjq.2016.11.007.Peer-Reviewed Original ResearchMeSH KeywordsCommunicationContinuity of Patient CareHospitals, UniversityHumansInterprofessional RelationsIschemic Attack, TransientOrganizational CulturePatient Care PlanningPatient Care TeamPatient DischargePrimary Health CareStrokeTransitional CareUnited StatesUnited States Department of Veterans AffairsConceptsTransitions of careClinical providersAcute settingDischarge documentationOutpatient providersStroke/transient ischemic attack patientsAcute stroke/TIATransient ischemic attack patientsVeterans Affairs Medical CenterStroke/TIAOutpatient primary carePrimary care clinicsPrimary care providersCare clinicsAcute careLongitudinal managementCare transitionsInpatient providersPrimary careProvider communicationAttack patientsTeaching hospitalComplete medicationMedical CenterDischarge communication