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(Stroke. 1996;27:1935-1936.)
© 1996 American Heart Association, Inc.

Articles

The Neurologist's Role in Stroke Management

Steven P. Ringel, MD

the Department of Neurology, University of Colorado Health Sciences Center (Denver).

Correspondence to Dr Ringel, University of Colorado Health Sciences Center, 4200 E Ninth Ave, B185, Denver, CO 80262.

Key Words: costs and cost analysis • stroke management • hospitalization

	Introduction

 
In this era of rigorous healthcare cost containment, neurologists need creative new ways to identify the value of the services we provide. Therefore, it is valuable to consider the outcomes and costs of hospitalized stroke patients under the care of neurologists compared with those under management by other physicians. In this issue of Stroke, Mitchell et al examine 90 days of claim data for 20% (38 612) of all Medicare patients hospitalized in 1991 with one of two stroke diagnoses (International Classification of Diseases, 9th revision, codes 434 and 436). Because the data come from a national database, we can look at a large, diverse Medicare population, identify services regardless of site of care or provider, and track individuals during and subsequent to hospitalization for a stroke.

Many hypotheses can be generated to explain the results of the analysis, which shows that when neurologists serve as the attending physicians, stroke patients have better outcomes but at a higher cost than when the principal care is provided by other physicians. Many neurologists may conclude that the additional expenses incurred by neurologists are probably justified because newer, more costly technology helps us provide more accurate diagnosis and effective treatment. But can we be sure that the outcomes and costs in this study truly reflect neurologists' value-added services, or are there other explanations for the findings?

Most of us are accustomed to weighing therapeutic decisions by analyzing the results of prospective controlled trials. Because the collection of that kind of primary outcome . . . [Full Text of this Article]

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