Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Department of Family Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Stroke Vasc Neurol. 2023 Feb;8(1):86-88. doi: 10.1136/svn-2022-001662. Epub 2022 Jul 28.
Patients with acute ischaemic strokes (AIS), on average, fare better with timely neurologist consultation, and a growing proportion of them receive one. However, little is known about trends in the characteristics of neurologists who treat AIS.
We identified AIS and transient ischaemic attack (TIA) episodes with neurologist consults in fee-for-service Medicare from January 2008 to September 2021. For each episode, we determined whether the neurologist was a vascular neurologist, was a high-volume provider, whether the patient was transferred between hospitals and the distance between the patient's home and physician's practice.
From 2008 to 2021, the share of AIS/TIA episodes (n=5 073 294) with neurologist consults increased (52.9% to 61.7%). Among episodes with consults, the fraction conducted by a vascular neurologist (5.2% to 13.7%) or by a high-volume neurologist (13.2% to 14.9%) also increased. The fraction with the patient's home and neurologist greater than 100 miles apart (4.8% to 9.6%) or in different states (5.1% to 8.1%) increased, as did the fraction with transfers (4.2% to 8.5%).
Over the study period, the proportion of AIS/TIA episodes with consultations from neurologists with either vascular neurology certifications or high volumes increased substantially.
急性缺血性脑卒中（AIS）患者平均而言，及时接受神经科医生的咨询会有更好的预后，而且越来越多的患者接受了这种咨询。然而，对于治疗 AIS 的神经科医生的特征趋势，人们知之甚少。
我们从 2008 年 1 月至 2021 年 9 月的按服务收费的医疗保险中确定了 AIS 和短暂性脑缺血发作（TIA）的发作，这些发作都有神经科医生的咨询。对于每一次发作，我们确定神经科医生是否为血管神经科医生，是否为高容量提供者，患者是否在医院之间转移以及患者的家和医生的实践之间的距离。
从 2008 年到 2021 年，有神经科医生咨询的 AIS/TIA 发作（n=5073294）比例增加（从 52.9%到 61.7%）。在有咨询的发作中，由血管神经科医生（从 5.2%到 13.7%）或高容量神经科医生（从 13.2%到 14.9%）进行的比例也有所增加。患者家和神经科医生之间的距离超过 100 英里（从 4.8%到 9.6%）或在不同州（从 5.1%到 8.1%）的比例增加了，转移的比例也增加了（从 4.2%到 8.5%）。
在研究期间，有神经科医生咨询的 AIS/TIA 发作中，具有血管神经病学认证或高容量的比例大幅增加。
