Sacchetti Daniel C, Gupta Ajay, Chung Caroline D, Chatterjee Abhinaba, Zhang Yi, Navi Babak B, Segal Alan Z, Kamel Hooman
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA.
Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
Neurohospitalist. 2020 Jul;10(3):181-187. doi: 10.1177/1941874420902951. Epub 2020 Feb 11.
We sought to determine the proportion of patients with ischemic stroke evaluated by vascular neurologists in the United States.
Using 2009 to 2015 claims from a 5% nationally representative sample of Medicare beneficiaries, we identified patients ≥65 years of age who were hospitalized for ischemic stroke. We ascertained the proportion of patients evaluated during the hospitalization or within 90 days of discharge by nonvascular and vascular neurologists. We assessed the relationship between county-level socioeconomic status and the likelihood of neurologist evaluation and between neurologist evaluation and diagnostic testing.
Among 66 989 patients with ischemic stroke, 37 820 (56.5%) were evaluated by a nonvascular neurologist and 11 700 (17.5%) by a board-certified vascular neurologist. Across increasing quartiles of county socioeconomic advantage, the proportion of patients evaluated by a vascular neurologist was 12.2%, 16.5%, 19.8%, and 23.0%. Relative to evaluation by a nonvascular neurologist, evaluation by a vascular neurologist was associated with a higher likelihood of postdischarge heart rhythm monitoring (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6-1.9), echocardiography (OR, 1.4; 95% CI, 1.3-1.4), cervical vessel imaging (OR, 1.3; 95% CI, 1.2-1.3), and intracranial vessel imaging (OR, 2.1; 95% CI, 2.0-2.2).
In a nationally representative cohort of Medicare beneficiaries, we found that about three quarters of patients with ischemic stroke were evaluated by a neurologist, and about one-sixth were evaluated by a vascular neurologist. Patients who were evaluated by a vascular neurologist were significantly more likely to undergo diagnostic testing.
我们试图确定在美国由血管神经科医生评估的缺血性中风患者的比例。
利用2009年至2015年来自5%具有全国代表性的医疗保险受益人的索赔数据，我们确定了65岁及以上因缺血性中风住院的患者。我们确定了在住院期间或出院后90天内由非血管神经科医生和血管神经科医生评估的患者比例。我们评估了县级社会经济地位与神经科医生评估可能性之间的关系，以及神经科医生评估与诊断测试之间的关系。
在66989例缺血性中风患者中，37820例（56.5%）由非血管神经科医生评估，11700例（17.5%）由获得委员会认证的血管神经科医生评估。随着县社会经济优势四分位数的增加，由血管神经科医生评估的患者比例分别为12.2%、16.5%、19.8%和23.0%。与由非血管神经科医生评估相比，由血管神经科医生评估与出院后心律监测（优势比[OR]，1.8；95%置信区间[CI]，1.6 - 1.9）、超声心动图（OR，1.4；95%CI，1.3 - 1.4）、颈部血管成像（OR，1.3；95%CI，1.2 - 1.3）和颅内血管成像（OR，2.1；95%CI，2.0 - 2.2）的可能性更高相关。
在一个具有全国代表性的医疗保险受益人群体中，我们发现约四分之三的缺血性中风患者由神经科医生评估，约六分之一由血管神经科医生评估。由血管神经科医生评估的患者进行诊断测试的可能性显著更高。
