Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists.
Health Serv Res
; 34(7): 1413-28, 2000 Mar.
Article
em En
| MEDLINE
| ID: mdl-10737445
ABSTRACT
OBJECTIVE:
This study evaluates the role of neurologists in explaining African American-white differences in the use of diagnostic and therapeutic services for cerebrovascular disease. DATA SOURCES/STUDYSETTING:
Medicare inpatient hospital records were used to identify a random 20 percent sample of patients age 65 and over hospitalized with a principal diagnosis of TIA between January 1, 1991 and November 30, 1991 (n = 17,437). STUDYDESIGN:
Medicare administrative data were used to identify five outcomemeasures:
noninvasive cerebrovascular tests, cerebral angiography, carotid endarterectomy, anticoagulant therapy (as proxied by outpatient prothrombin time tests), and the specialty of the attending physician (neurologist versus other specialist). DATA COLLECTION/EXTRACTIONMETHODS:
All Medicare claims were extracted for a 30-day period beginning with the date of admission. PRINCIPALFINDINGS:
Even after adjusting for patient demographics, comorbidity, ability to pay, and provider characteristics, African American patients were significantly less likely to receive noninvasive cerebrovascular testing, cerebral angiography, or carotid endarterectomy, compared with white patients, and to have a neurologist as their attending physician. At the same time, patients treated by neurologists were more likely to undergo diagnostic testing and less likely to undergo carotid endarterectomy.CONCLUSIONS:
The findings suggest that African American patients with TIA may have less access to services for cerebrovascular disease and that at least some of this may be attributed to less access to neurologists. More research is needed on how patients at risk for stroke are referred to specialists.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Negro ou Afro-Americano
/
Padrões de Prática Médica
/
Ataque Isquêmico Transitório
/
Seleção de Pacientes
/
População Branca
/
Neurologia
Tipo de estudo:
Prognostic_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Health Serv Res
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Estados Unidos