Racial variation in treatment for transient ischemic attacks: Impact of participation by neurologists

Objective. This study evaluates the role of neurologists in explaining Afri can American-white differences in the use of diagnostic and therapeutic ser vices for cerebrovascular disease. Data Sources/Study Setting. Medicare inpatient hospital records were used t o identify a random 20 percent sample of patients age 65 and over hospitali zed with a principal diagnosis of TIA between January 1, 1991 and November 30, 1991 (n = 17,437). Study Design. Medicare administrative data were used to identify five outco me measures: noninvasive cerebrovascular tests, cerebral angiography, carot id endarterectomy, anticoagulant therapy (as proxied by outpatient prothrom bin time tests), and the specialty of the attending physician (neurologist versus other specialist). Data Collection/Extraction Methods. All Medicare claims were extracted for a 30-day period beginning with the date of admission. Principal Findings. Even after adjusting for patient demographics, comorbid ity, ability to pay, and provider characteristics, African American patient s were significantly less likely to receive noninvasive cerebrovascular tes ting, cerebral angiography, or carotid endarterectomy, compared with white patients, and to have a neurologist as their attending physician. At the sa me time, patients treated by neurologists were more likely to undergo diagn ostic testing and less likely to undergo carotid endarterectomy. Conclusions. The findings suggest that African American patients with TIA m ay have less access to services for cerebrovascular disease and that at lea st some of this may be attributed to less access to neurologists. More rese arch is needed on how patients at risk for stroke are referred to specialis ts.