title: Resource utilization and outcome at a university versus a community teaching hospital in tPA treated stroke patients: a retrospective cohort study.
abstract: BACKGROUND
  Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. Stroke patients treated with tissue plasminogen activator (tPA) provide a particularly homogenous population for comparison because of strict eligibility criteria for treatment. We tested whether resource utilization would be similar in this homogenous population between two hospitals located in a single Midwestern US community by comparing use of diagnostic testing and associated outcomes following treatment with t-PA.
  
  
  METHODS
  Medical records from 206 consecutive intravenous t-PA-treated stroke patients from two teaching hospitals (one university, one community-based) were reviewed. Patient demographics, clinical characteristics and outcome were analyzed, as were the frequency of use of CT, MRI, MRA, echocardiography, angiography, and EEG.
  
  
  RESULTS
  Seventy-nine and 127 stroke patients received t-PA at the university and community hospitals, respectively. The two patient populations were demographically similar. There were no differences in stroke severity. All outcomes were similar at both hospitals. Utilization of CT scans, and non-invasive carotid and cardiac imaging studies were similar at both hospitals; however, brain MR, TEE, and catheter angiography were used more frequently at the university hospital. EEG was obtained more often at the community hospital.
  
  
  CONCLUSIONS
  Utilization of advanced brain imaging and invasive diagnostic testing was greater at the university hospital, but was not associated with improved clinical outcomes. This could not be explained on the basis of stroke severity or patient characteristics. This variation of practice suggests substantial opportunities exist to reduce costs and improve efficiency of diagnostic resource use as well as reduce patient exposure to risk from diagnostic procedures.
authors.affiliation: Department of Psychiatry, University of Michigan, Commonwealth Blvd, Ann Arbor, MI, USA. angif@umich.edu
authors.forename: Angela F
authors.initials: AF
authors.lastname: Caveney
authors.forename: Robert
authors.initials: R
authors.lastname: Silbergleit
authors.forename: Shirley
authors.initials: S
authors.lastname: Frederiksen
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hickenbottom
authors.forename: Rodney W
authors.initials: RW
authors.lastname: Smith
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Scott
mesh_terms: D000368:Aged; D003153:Community Health Services; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D015146:Midwestern United States; D017063:Outcome Assessment, Health Care / Q000379:methods*; D040841:Resource Allocation; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014600:Utilization Review
chemical_list: D010959:Tissue Plasminogen Activator