Abstract 3376: Utilization of Physician Services within the First Month after Hospitalization for Ischemic Stroke
Background: Stroke poses significant burdens on patients, their families, and informal caregivers in the days following hospitalization. Limited data are available assessing patient use of immediate poststroke outpatient services. Service utilization patterns have implications for understanding continuity of care and may affect 30-day mortality and readmission rates, measures being used in other conditions as indicators of the quality and efficiency of hospital-leve care.
Objective: To determine physician specialty, frequency, and most common reasons for physician office visits for Medicare beneficiaries within 30 days of hospital discharge after an ischemic stroke.
Methods: Data were derived by linking a 5% sample of Part B Medicare data (physician carrier file) with Part A inpatient data. The study cohort included fee-for-service beneficiaries 65+ years of age with a primary discharge diagnosis of ischemic stroke (ICD-9 433, 434, 436) in 2006 with linked in-patient and physician visit data. The 10 most frequent reasons for physician office visits were identified using principal ICD-9 diagnosis codes. Physician specialty was identified using the CMS provider specialty code.
Results: Among 10,230 identified ischemic stroke patients, 9,523 were discharged alive and included in the study. Of these patients, 16% were rehospitalized for any cause, 42% had at least one hospital outpatient visit, and 88% had at least one physician office visit within 30 days. Primary reasons for physician office visits included stroke, atrial fibrillation, hypertension, diabetes, and heart failure (Table). Internists were seen most frequently, followed by radiologists, cardiologists, and family practice physicians. There were 1,449 visits to neurologists and 1,355 visits to physical medicine and rehabilitation physicians.
Conclusion: Almost 90% of Medicare beneficiaries discharged with ischemic stroke were seen in a physician’s office within the first month. Reasons for visits included stroke as well as other cardiovascular conditions and common stroke risk factors. Additional research is needed to determine the accuracy of physician codes for follow-up visits as well as to assess how the utilization of outpatient services within the early recovery period influences 30-day mortality and readmission rates.
- © 2012 by American Heart Association, Inc.