Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists.
OBJECTIVE
This study evaluates the role of neurologists in explaining African American-white differences in the use of diagnostic and therapeutic services for cerebrovascular disease.


METHODS
Medicare inpatient hospital records were used to identify a random 20 percent sample of patients age 65 and over hospitalized with a principal diagnosis of TIA between January 1, 1991 and November 30, 1991 (n = 17,437).


METHODS
Medicare administrative data were used to identify five outcome measures: noninvasive cerebrovascular tests, cerebral angiography, carotid endarterectomy, anticoagulant therapy (as proxied by outpatient prothrombin time tests), and the specialty of the attending physician (neurologist versus other specialist).


METHODS
All Medicare claims were extracted for a 30-day period beginning with the date of admission.


RESULTS
Even after adjusting for patient demographics, comorbidity, ability to pay, and provider characteristics, African American patients were significantly less likely to receive noninvasive cerebrovascular testing, cerebral angiography, or carotid endarterectomy, compared with white patients, and to have a neurologist as their attending physician. At the same time, patients treated by neurologists were more likely to undergo diagnostic testing and less likely to undergo carotid endarterectomy.


CONCLUSIONS
The findings suggest that African American patients with TIA may have less access to services for cerebrovascular disease and that at least some of this may be attributed to less access to neurologists. More research is needed on how patients at risk for stroke are referred to specialists.
Mitchell
J B
JB
Health Economics Research Inc., Waltham, MA 02452-8414, USA.
Ballard
D J
DJ
Matchar
D B
DB
Whisnant
J P
JP
Samsa
G P
GP
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009462:Neurology / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D014481:United States; D044465:White People / Q000706:statistics & numerical data*