Background: On July 1, 2015, a 315 bed, level one trauma center changed the delivery of inpatient stroke care. Prior to the transition, stroke patients were admitted and managed primarily by the neurology team. Post transition, stroke patients were admitted under the care of hospitalists, with neurologists utilized as consultants for stroke related care. No previous studies have examined the transition of stroke care within a single hospital. This study compares the effects of physician specialty on stroke care and patient outcome.
Methods: A retrospective cohort study of 399 patients with ischemic stroke and TIA, treated 14 months pre-and-post a change in stroke care delivery (May 1, 2014 - September 20, 2016), was conducted. ICD-9 and ICD-10 codes were utilized to extract patient information including stroke care and outcome measures, such as prescriptions, diagnostic examination orders, hospital length of stay, mortality, discharge location, and 30-day readmission rates. Chi-square and logistic regression statistical analyses were performed using SAS statistical software.
Results: 287 patients were treated primarily by a neurology team, while 112 patients were treated primarily by a hospitalist team. The average patient age was 61.2 (±13.2) years old. There was no meaningful difference in provision of stroke care between the hospitalist and neurologist teams as measured by 20 stroke care measures including, provision of diagnostic examinations and prescriptions. While patients on the hospitalist teams were found to have statistically shorter length of hospital stay (median (range) = 2 (0-50) days vs. 3 (0 - 46), p<0.01), there were no statistical differences between 30-day readmission rates (17.9% vs. 14.6%, p=0.42), in-hospital mortality (2.7% vs. 4.5%, p=0.57), 30-day all-cause mortality (2.7% vs. 5.9%, p=0.21), or discharge disposition (p=0.45).
Conclusions: There is no evidence that patients received dissimilar stroke related care or experienced different outcomes regardless of the physician specialty serving as the primary service. However, stroke patients with hospitalists as their primary team had shorter hospital stay. This difference may be due to hospitalists’ expertise in managing patients with multiple co-morbidities, including stroke patients with underlying diabetes, atrial fibrillation, and hypertension. Based on these findings, utilizing neurology as a consult service for stroke related care will not affect provision of stroke care or patient outcomes.