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Neurologists treating stroke patients were significantly more expensive than other physicians but obtained better outcomes.Ninety-day mortality rates for patients treated by neurologists were significantly lower than those for other\specialists.These cost and outcome differences persisted even after adjustment for patient age,comorbidity,hospital teaching status,and other characteristics.Compared with other attending physicians, neurologists were significantly more likely to order diagnostic cerebrovascular tests(especially brain MRI scans),more likely to prescribe warfarin,and more likely to discharge patients to inpatient rehabilitation facilities.Systematic triaging to neurologists based on clinical characteristics unmeasured by administrative data might explain these observed differences between neurologists and other physicians. Alternatively,these specialists may have been better able to identify the mechanism of stroke,information that then affected the course of treatment.Given current pressures to substitute generalists for specialists,however,more research is needed on these stroke treatment differences. |
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