30-day survival and rehospitalization for stroke patients according to physician specialty.
OBJECTIVE
Stroke patients appear to have improved outcomes when cared for by neurologists, but the mechanism by which improved outcome is achieved is unclear. This study compares 30-day cause-specific rehospitalization, 30-day mortality, and specific processes of care for patients treated by a neurologist only, a generalist only, a neurologist and a generalist (i.e., collaborative care), or by another specialist during the index hospitalization.


METHODS
This study uses Cox regression to analyze claims and enrollment data from 44,099 Medicare beneficiaries 65 years of age and older and discharged with acute ischemic stroke from 1998 to 2000 in 11 US metropolitan regions.


RESULTS
Patients seen by neurologists had more severe strokes than patients seen by generalists, though patients seen by generalists had more comorbidities. Patients seen by neurologists (alone or collaboratively) had a 10 and 16% lower risk of 30-day mortality, respectively. Patients seen by a neurologist only had a 12% lower risk of rehospitalization for infections and aspiration pneumonitis. In contrast, patients seen by neurologists had a higher risk of rehospitalization for atherosclerotic (cardiovascular and non-acute cerebrovascular) disease. Patients seen by neurologists were more likely to be discharged to inpatient rehabilitation, had longer lengths of stay, and were more likely to receive warfarin after discharge.


CONCLUSIONS
Results support the hypothesis that neurologists improve outcomes specifically by reducing the potential for aspiration (through increased swallowing evaluations) or by improving functioning (through use of rehabilitation therapy). Future studies should continue to examine the mechanisms by which neurologists may achieve better outcomes in stroke care.
Smith
Maureen A
MA
Department of Population Health Sciences, University of Wisconsin-Madison Medical School, Madison, Wisc, USA. maureensmith@wisc.edu
Liou
Jinn-Ing
JI
Frytak
Jennifer R
JR
Finch
Michael D
MD
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012044:Regression Analysis; D013038:Specialization; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin