Methods:
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.
Results:
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).
Conclusions:
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.
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