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Abstract
Objective: We aimed to compare the rates of thrombolysis utilization for acute ischemic stroke in hospitals with neurology residency (NR) to those of other teaching (OT) and nonteaching (NT) hospitals.
Methods: A retrospective serial cross-sectional cohort study of a nationally representative sample of stroke patients was conducted. Accreditation Council for Graduate Medical Education–accredited NR program–affiliated hospitals in the United States were cross-matched to the hospitals in the Nationwide Inpatient Sample from 2000 to 2010. ICD-9-CM codes were used for case ascertainment.
Results: A total of 712,433 adult ischemic stroke patients from 6,839 hospital samples were included, of whom 10.1%, 29.1%, and 60.8% were treated in NR, OT, and NT hospitals, respectively. Stroke patients in NR received thrombolysis more frequently (3.74% ± 0.24% [standard error]) than in OT (2.28% ± 0.11%, p < 0.001) and NT hospitals (1.44% ± 0.06%, p < 0.001). The adjusted odds ratios (ORs) of thrombolysis rates in NR vs OT and NR vs NT increased with each decade increment in age. In multivariate analysis, NR was independently predictive of higher thrombolysis rate (adjusted OR 1.51; 95% confidence interval [CI] 1.44–1.59 [NR vs OT], and adjusted OR 1.82; 95% CI 1.73–1.91 [NR vs NT]).
Conclusions: Acute stroke care in NR hospitals is associated with an increased thrombolytic utilization. The disparities between the thrombolysis rate in NR and that in OT and NT hospitals are greater among elderly patients.
GLOSSARY
- AIS=
- acute ischemic stroke;
- CCI=
- Charlson comorbidity index;
- CI=
- confidence interval;
- HCUP=
- Healthcare Cost and Utilization Project;
- HHS=
- Health and Human Services;
- ICD-9-CM=
- International Classification of Diseases, Ninth Revision, Clinical Modification;
- JC-PSC=
- Joint Commission–certified Primary Stroke Center;
- NIS=
- Nationwide Inpatient Sample;
- NR=
- neurology residency;
- NT=
- nonteaching;
- OR=
- odds ratio;
- OT=
- other teaching;
- tPA=
- tissue plasminogen activator
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1972
Supplemental data at www.neurology.org
- Received May 1, 2013.
- Accepted in final form July 30, 2013.
- © 2013 American Academy of Neurology
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