Introduction: Given recent advances in diagnostic and therapeutic tools, delivery of stroke care has become more complex. We sought to investigate what proportion of patients with stroke are evaluated by neurologists, and specifically by vascular neurologists.
Methods: Using 2008-2015 claims data from a 5% nationally representative sample of Medicare beneficiaries, we identified all patients >65 years of age who were hospitalized for ischemic stroke, as defined by previously validated ICD-9-CM codes. Our primary outcome was the proportion of patients evaluated during the stroke hospitalization or within 90 days of discharge by a neurologist, as determined from evaluation and management CPT codes and Medicare provider specialty codes. To ascertain which of these neurologists were vascular neurologists, we used a Python script and National Provider Identifier numbers to merge in publicly available data from the American Board of Psychiatry and Neurology on all board-certified vascular neurologists in the U.S. As a comparison, we used previously validated diagnosis codes to identify patients hospitalized with acute myocardial infarction (MI) and determined the proportion seen by a cardiologist during the hospitalization or within 90 days of discharge. Statistical analysis involved descriptive statistics with exact confidence intervals (CI)s and the chi-square test.
Results: Among 66,989 patients with ischemic stroke, 49,335 (73.7%; 95% CI, 73.1-74.0%) were evaluated by a neurologist. A board-certified vascular neurologist evaluated 11,001 patients, equating to 16.4% (95% CI, 16.1-16.7%) of all stroke patients and 22.3% (95% CI, 21.9-22.7%) of stroke patients seen by a neurologist. In comparison, a cardiologist evaluated 53,481 of 61,232 patients with acute MI (87.3%; 95% CI, 87.1-87.6%), a proportion significantly higher than the proportion of stroke patients seen by a neurologist (P <0.001).
Conclusions: In a nationally representative cohort of Medicare beneficiaries, we found that approximately 75% of patients with ischemic stroke were evaluated by a neurologist, a proportion significantly lower than the comparable metric for acute MI. Furthermore, about one of every six stroke patients was evaluated by a vascular neurologist.