Specialists provide better care for stroke

Stroke patients who receive care from neurologists may pay more but often have better outcomes, according to a recent study published in the journal Stroke.

Researchers analyzed claims data for a random 20% sample of Medicare patients admitted to the hospital with nonhemorrhagic stroke in 1991. Study findings include the following:

• Study patients treated by neurologists had a 31% lower death rate at three months than patients treated by internists and a 36% lower death rate than patients treated by family practitioners.

• Patients cared for by neurologists had higher functional levels after their hospital stay than those treated by non-neurologists.

• Neurologists were 34% more expensive than family practitioners and 22% more expensive than internists or other specialists.

Researchers suggest that several dimensions of stroke management by neurologists may be relevant to both the increased costs and improved outcomes. Those include the following:

• Neurologists are significantly more likely to order diagnostic cerebrovascular tests, especially brain scans, which often identify the pathophysiologic mechanism of the stroke and may affect the course of treatment.

• Neurologists are more likely to prescribe the anticoagulant warfarin and to begin early rehabilitation.

[See: Mitchell J, Ballard DJ, Whisnant JP, et al. What role do neurologists play in determining the costs and outcomes of stroke patients? Stroke 1996; 27:1,937-1,943.]