How are TIAs managed in a managed care setting? Resource use and costs.
This pilot study performed by members of the Greater Cincinnati / Northern Kentucky Stroke Team describes the retrospective examination of administrative claims data involving TIA survivors from a locally based managed care program. New TIA cases were identified between November 1997 and July 1998 and defined by an absence of a primary ICD9 code for a TIA or ischemic stroke during preceding 10–12 months. The managed care organization provided all inpatient hospital, outpatient hospital, ambulatory care and prescription claims for 12 months prior to and after the new case. Cases (n = 51) averaged 54.5 years of age and 56.9% were males. Predominant comorbidities included: hypertension (45.1%), and hypercholesterolemia (47.1%). Eight (15.7%) were hospitalized for their TIA. Total health care costs increased by only $568 from the period prior to the TIA. This limited increase in costs led us to question how these cases were evaluated and treated. We then compared the resources utilized to the AHA Stroke Council’s 1999 Supplement to Guidelines for the Management of Transient Ischemic Attacks and the 1997 AHA Practice Guidelines for Use of Imaging. This comparison was made to determine if these managed care enrollees received the recommended diagnostic evaluation and follow-up care directed towards the prevention of subsequent major cerebrovascular events. An analysis of the specific components of the managed care evaluation will be provided.