Smith Maureen A, Liou Jinn-Ing, Frytak Jennifer R, Finch Michael D
Department of Population Health Sciences, University of Wisconsin-Madison Medical School, Madison, Wisc, USA.
Cerebrovasc Dis. 2006;22(1):21-6. doi: 10.1159/000092333. Epub 2006 Mar 27.
Stroke patients appear to have improved outcomes when cared for by neurologists, but the mechanism by which improved outcome is achieved is unclear. This study compares 30-day cause-specific rehospitalization, 30-day mortality, and specific processes of care for patients treated by a neurologist only, a generalist only, a neurologist and a generalist (i.e., collaborative care), or by another specialist during the index hospitalization.
This study uses Cox regression to analyze claims and enrollment data from 44,099 Medicare beneficiaries 65 years of age and older and discharged with acute ischemic stroke from 1998 to 2000 in 11 US metropolitan regions.
Patients seen by neurologists had more severe strokes than patients seen by generalists, though patients seen by generalists had more comorbidities. Patients seen by neurologists (alone or collaboratively) had a 10 and 16% lower risk of 30-day mortality, respectively. Patients seen by a neurologist only had a 12% lower risk of rehospitalization for infections and aspiration pneumonitis. In contrast, patients seen by neurologists had a higher risk of rehospitalization for atherosclerotic (cardiovascular and non-acute cerebrovascular) disease. Patients seen by neurologists were more likely to be discharged to inpatient rehabilitation, had longer lengths of stay, and were more likely to receive warfarin after discharge.
Results support the hypothesis that neurologists improve outcomes specifically by reducing the potential for aspiration (through increased swallowing evaluations) or by improving functioning (through use of rehabilitation therapy). Future studies should continue to examine the mechanisms by which neurologists may achieve better outcomes in stroke care.
由神经科医生护理的中风患者似乎预后更佳，但改善预后的机制尚不清楚。本研究比较了在首次住院期间仅由神经科医生、仅由全科医生、神经科医生和全科医生（即协作护理）或由其他专科医生治疗的患者的30天特定病因再入院率、30天死亡率及特定护理流程。
本研究使用Cox回归分析了1998年至2000年期间美国11个大都市地区44099名65岁及以上因急性缺血性中风出院的医疗保险受益人的索赔和登记数据。
与由全科医生治疗的患者相比，由神经科医生治疗的患者中风更严重，不过由全科医生治疗的患者合并症更多。由神经科医生（单独或协作）治疗的患者30天死亡率分别降低了10%和16%。仅由神经科医生治疗的患者因感染和吸入性肺炎再入院的风险降低了12%。相比之下，由神经科医生治疗的患者因动脉粥样硬化（心血管和非急性脑血管）疾病再入院的风险更高。由神经科医生治疗的患者更有可能出院后入住 inpatient rehabilitation（此处inpatient rehabilitation未翻译完整，可能是“住院康复”之类的意思），住院时间更长，出院后更有可能接受华法林治疗。
结果支持以下假设，即神经科医生通过减少误吸可能性（通过增加吞咽评估）或通过改善功能（通过使用康复治疗）来具体改善预后。未来的研究应继续探讨神经科医生在中风护理中可能取得更好预后的机制。
