Neurologists provide better stroke care

Internists, family practitioners don’t fare as well

Stroke patients who receive care from neurologists may get a larger bill but often have better outcomes, a recent study finds.¹ Researchers analyzed claims data for a random 20% sample of Medicare patients admitted to the hospital with nonhemorrhagic stroke in 1991 and found:

• 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 specialists may be relevant to both the increased costs and improved outcomes, such as:

• 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 begin early rehabilitation.

^Reference

^{1. 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.}