title: Organized outpatient care: stroke prevention clinic referrals are associated with reduced mortality after transient ischemic attack and ischemic stroke.
abstract: OBJECTIVE
  Organized inpatient stroke care decreases mortality and morbidity irrespective of patient age, stroke severity, or stroke subtype. Limited information is available on whether organized outpatient care models such as stroke prevention clinics (SPC) improve outcomes after a transient ischemic attack or ischemic stroke. We compared 1-year mortality and stroke readmission in patients with transient ischemic attack or ischemic stroke referred versus not referred to an SPC.
  
  
  METHODS
  This was a retrospective cohort study including 16,468 consecutive patients with ischemic stroke or transient ischemic attack who were seen in the emergency department or admitted to a hospital between July 1, 2003 and March 31, 2008 at registry stroke centers (n=12) in the province of Ontario. Cox proportional hazards models and propensity score-matched analyses were used to evaluate 1-year mortality and readmission.
  
  
  RESULTS
  One-year mortality rates were lower in those referred to SPCs compared with those not referred, even after adjustment for age, sex, ethnic origin, income, comorbid conditions, stroke symptoms and severity, receipt of thrombolysis, stroke unit care, discharge destination, and functional status at discharge (adjusted hazard ratio [HR], 0.67; 95% CI, 0.60-0.75). Survival analysis after propensity matching showed a 26% reduction in 1-year mortality (HR, 0.74; 95% CI, 0.65-0.84). There were no significant differences in 1-year readmission rates in those referred versus not referred to SPCs.
  
  
  CONCLUSIONS
  Referral to an SPC is associated with a one-quarter reduction in mortality after ischemic stroke or transient ischemic attack. This supports the argument that outpatient stroke units may prove as effective as their inpatient counterparts.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, M5G 1V7, Canada. fiona.webster@utoronto.ca
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Chris
authors.initials: C
authors.lastname: O'Callaghan
authors.forename: Vladimir
authors.initials: V
authors.lastname: Hachinski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000639:trends*; D000554:Ambulatory Care Facilities / Q000639:trends*; D002545:Brain Ischemia / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012017:Referral and Consultation / Q000639:trends; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy*