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Relationship between physician specialty and the selection and outcome of ischemic stroke patients
R D Horner1, D B Matchar, G W Divine
1Center for Health Services Research in Primary Care, HSR&D Field Program, Veterans Affairs Medical Center, Durham, NC 27705, USA.
Objective:
This study compares the initial characteristics, in-hospital treatment, and outcomes of stroke patients managed by neurologists versus non-neurologists.
Data Sources/Study Setting:
An inception cohort of 146 patients hospitalized with their first stroke at a private, a university, or a Veterans Affairs hospital.
Study Design:
A prospective, hospital-based, multisite cohort study design is used to ascertain the patients' initial 180-day in-hospital and postdischarge experience.
Data Collection/Extraction Methods:
Data were collected on patient demographics, disease severity, and risk factors for stroke; diagnostic tests and pharmacologic management; one-month and six-month all-cause and cause-specific mortality; and physical and functional impairment.
Principal Findings:
The 88 patients (60 percent) admitted to the neurology services of the study hospitals had better prognostic profiles, i.e., lower likelihood of having either completed stroke or cardiac comorbidity, and were less likely to die within one and six months of stroke onset.
Conclusions:
Substantial systematic differences in the types of patients managed by neurologists versus other specialists may preclude comparison of outcomes of care.