Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina.
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):938-45. doi: 10.1016/j.jstrokecerebrovasdis.2011.11.004. Epub 2011 Dec 22.
Inpatient stroke utilization may be decreasing over time and may vary by patient demographics. Less is known about temporal trends and demographic variations in outpatient stroke utilization. We assessed ischemic stroke (IS)-related outpatient utilization across physician specialty and time, exploring any demographic variability, using recent US population-based data.
We identified all outpatient medical visits for IS by adults (≥ 18 years) using the National Ambulatory Medical Care Survey (NAMCS) years 1998 to 2009. Physician numbers were derived from American Medical Association or American Osteopathic Association data by NAMCS. We assessed IS-related outpatient visits to neurologists and generalists over time and by patient demographics.
We identified 9.7 million IS-related visits from 1998 to 2009. The rate of IS-related visits to neurologists increased from 0.56 million visits in 1998 to 2000 to 0.90 million visits in 2007 to 2009, representing a 62% increase over the study period. The rate of IS-related visits to generalists declined from 2.0 million visits in 1998 to 2000 to 1.6 million visits in 2007 to 2009 (18% decrease). Between 1998 and 2009, the number of neurologists increased by 23% and the number of generalists grew by 19%. The IS visit rate per 100 physicians increased by 90% for neurologists but decreased by 31% for generalists. Fewer ambulatory IS-related visits to neurologists were reported among stroke survivors who were older, female, nonwhite, or living in rural areas.
Between 1998 and 2009, IS-related outpatient utilization increased substantially to neurologists but declined to generalists. We identified demographic variations in outpatient utilization of neurologists that potentially lead to disparities in stroke evaluation and management.
住院脑卒中患者的数量可能随时间推移而减少，且可能因患者人口统计学特征而异。关于门诊脑卒中患者的利用情况随时间的变化趋势和人口统计学特征的差异，人们了解得较少。本研究使用最近的美国基于人群的数据，评估了不同医师专业和时间的缺血性脑卒中（IS）相关门诊利用情况，并探讨了任何可能存在的人口统计学差异。
我们通过 1998 年至 2009 年的国家门诊医疗调查（NAMCS），确定了所有≥18 岁成人的门诊 IS 就诊记录。NAMCS 中的医师数量是根据美国医学协会或美国骨疗协会的数据推算得出的。我们评估了不同时间和患者人口统计学特征下，IS 相关门诊就诊于神经科医生和普通科医生的情况。
本研究共纳入了 1998 年至 2009 年间 970 万例 IS 相关门诊就诊记录。IS 相关门诊就诊于神经科医生的比例从 1998 年至 2000 年的 56 万例增加到 2007 年至 2009 年的 90 万例，在研究期间增加了 62%。IS 相关门诊就诊于普通科医生的比例从 1998 年至 2000 年的 200 万例下降到 2007 年至 2009 年的 160 万例（下降了 18%）。1998 年至 2009 年间，神经科医生的数量增加了 23%，普通科医生的数量增加了 19%。神经科医生每 100 名医师的 IS 就诊率增加了 90%，而普通科医生的这一比例则下降了 31%。在脑卒中幸存者中，年龄较大、女性、非裔或居住在农村地区的患者，其报告的门诊 IS 相关就诊次数较少。
1998 年至 2009 年间，IS 相关门诊就诊于神经科医生的比例大幅增加，但就诊于普通科医生的比例下降。我们发现，神经科医生的门诊利用率存在人口统计学差异，这可能导致脑卒中评估和管理方面的差异。
