Stroke Prevention Practices Differ Significantly between United States and United Kingdom

February 09, 1997

DURHAM, N.C. -- Older people who suffer strokes appear to have a better chance of survival, with less disability, if they are cared for primarily by a neurologist rather than a medical generalist while in the hospital, according to a study of Medicare outcomes data.

The study, led by researchers at the Center for Health Policy Research and Evaluation (CHPRE) at Duke University Medical Center, found that disability and death from stroke are influenced by whether a neurologist or a non-specialist cares for the patient. Of the more than 350,000 people over age 65 who have strokes each year, about half are never seen by a neurologist, the researchers said.

The findings are reported in the November issue of the journal Stroke. This study was supported as part of a five-year project, the Stroke Patient Outcomes Research Team, funded by the federal Agency for Health Care Policy and Research. The study principal investigator is Dr. David Matchar of Duke.

"The findings are important in the context of changing patterns of care, in particular the growth of managed care," said Gregory Samsa, assistant professor, Center for Health Services Research, Rockville, Md., and project director of the study. "We need to know when redirecting patient care to generalists is both cost-effective and does not adversely affect patients. Our study indicates neurologists are a good value in the long run both for patients and the bottom-line."

The researchers found that: As a result, the cost of hospitalization was higher when a neurologist cared for the patient, but those patients had less disability.

"While the initial costs may be slightly higher, the decrease in long-term disability may actually lower the overall cost of caring for stroke patients," Samsa said.

The research team analyzed the claims of 38,612 Medicare patients diagnosed with a stroke in 1991. All patients were over age 65.

About 11 percent were cared for by a neurologist. One-fourth of patients were treated by both a neurologist and a generalist. Almost half were treated by a generalist physician only. The remainder were cared for by other types of specialists or their primary physician was not identified.

The researchers noted the lower death rate for people cared for by neurologists could not be accounted for by the availability of advanced technology at the admitting hospital.

"When a person has a stroke, we know that early treatment makes the biggest difference in outcomes," said Janet Mitchell of Health Economics Research Inc., Waltham, Mass., a private research organization, and the lead author of the study. "It may be that neurologists' experience and knowledge of the various treatment options, such as anticoagulant therapy can give patients an advantage."

The study adjusted for age, gender, race, other complicating diseases such as diabetes, and history of previous strokes. However, Samsa said the interpretation of the study is limited because Medicare data does not include detailed patient data, such as information about the severity of stroke.

"It may be that patients with a more severe stroke are sent to medical intensive care units that are staffed by internists," said Dr. Larry Goldstein, a Duke neurologist and member of CHPRE. "The study raises legitimate issues of why this difference in outcomes exists."

Many hospitals don't have specialized stroke units, where patients are treated by a multidisciplinary team that involves early rehabilitation, which has been shown to decrease long-term disability, Goldstein said. "The next step should be to find out the reasons for these differences, and then, if appropriate, to disseminate this information to generalist physicians because they care for the majority of stroke patients in this country. Neurologists can be leaders in that effort," he said.

The research team also included Dr. David Ballard of Emory University, Atlanta; Dr. Jack Whisnant of the Mayo Clinic, Rochester, Minn.; and Carol Ammering of Health Economics Research Inc.
-end-


Duke University

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.