title: Association between hospitalization and care after transient ischemic attack or minor stroke.
abstract: OBJECTIVE
  To evaluate the care and outcomes of patients with TIA or minor stroke admitted to the hospital vs discharged from the emergency department (ED).
  
  
  METHODS
  We used the Ontario Stroke Registry to create a cohort of patients with minor ischemic stroke/TIA who presented to the hospital April 1, 2008, to March 31, 2009, or April 1, 2010, to March 31, 2011, in the province of Ontario, Canada. We compared processes of care and outcomes (death or recurrent stroke/TIA) in patients admitted to the hospital and discharged with and without stroke prevention clinic follow-up.
  
  
  RESULTS
  In our sample of 8,540 patients, the use of recommended interventions was highest in admitted patients, followed by discharged patients referred to prevention clinics, followed by those discharged without clinic referral. Eight percent of nonadmitted patients returned to the hospital with recurrent stroke/TIA within 1 week of the index event. One-year stroke case-fatality was similar in admitted and discharged patients (adjusted hazard ratio 1.11; 95% confidence interval 0.92-1.34). Among patients discharged from EDs, referral to a stroke prevention clinic was associated with a markedly lower risk of mortality (adjusted hazard ratio 0.49; 95% confidence interval 0.38-0.64).
  
  
  CONCLUSIONS
  Patients with minor ischemic stroke or TIA discharged from the ED are less likely than admitted patients to receive timely stroke care interventions. Among discharged patients, referral to a stroke prevention clinic is associated with improved processes of care and lower mortality. Additional strategies are needed to improve access to high-quality outpatient TIA care.
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada. moira.kapral@uhn.ca.
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gladstone
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Leanne K
authors.initials: LK
authors.lastname: Casaubon
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Stamplecoski
authors.affiliation: From the Institute for Clinical Evaluative Sciences (M.K.K., R.H., J.F., P.C.A., F.L.S., D.J.G., M.S., J.V.T.), Toronto; Department of Medicine (M.K.K., F.L.S., D.J.G., L.K.C., J.V.T.), University of Toronto; Institute of Health Policy, Management and Evaluation (M.K.K., R.H., P.C.A., J.V.T.), Toronto; Division of General Internal Medicine and Toronto General Research Institute (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Sunnybrook Research Institute (M.K.K., D.J.G., J.V.T.), Toronto; and Divisions of Neurology (D.J.G.) and Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome