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Background: Follow-up is critically important for stroke survivors with diabetes, yet there is limited research about the quality of diabetes care that these patients receive. We investigated performance on diabetes quality of care indicators for stroke survivors overall and by race. Methods: Claims data was extracted for 1,460 Medicare beneficiaries with preexisting diabetes who survived hospitalization for acute ischemic stroke in 2000. Adjusted probabilities of receiving HbA1c, LDL and dilated eye exams were estimated using logistic regression. Results: 53% had a dilated eye exam, 60% received an LDL check, 73% percent had their HbA1c checked at least once and only 51% received two or more HbA1c checks. In the unadjusted results, blacks were significantly less likely than whites to receive these tests. Conclusions:Care of stroke survivors, particularly blacks, shows gaps according to guidelines.

Background and Purpose: Stroke patients appear to have improved outcomes when cared for by neurologists, but the mechanism by which improved outcome is achieved is unclear. This study compares 30-day cause-specif ic rehospitalization, 30-day mortality, and specific processes of care for patients treated by a neurologist only, a generalist only, a neurologist and a generalist (i.e., collaborative care), or by another specialist during the index hospitalization.Methods: This study uses Cox regression to analyze claims and enrollment data from 44,099 Medicare beneficiaries 65 years of age and older and discharged with acute ischemic stroke from 1998 to 2000 in 11 US metropolitan regions. Results: Patients seen by neurologists had more severe strokes than patients seen by generalists, though patients seen by generalists had more comorbidities. Patients seen by neurologists (alone or collaboratively) had a 10 and 16% lower risk of 30-day mortality, respectively. Patients seen by a neurologist only had a 12% lower risk of rehospitalization for infections and aspiration pneumonitis. In contrast, patients seen by neurologists had a higher risk of rehospitalization for atherosclerotic (cardiovascular and non-acute cerebrovascular) disease. Patients seen by neurologists were more likely to be discharged to inpatient rehabilitation, had longer lengths of stay, and were more likely to receive warfarin after discharge. Conclusions: Results support the hypothesis that neurologists improve outcomes specifically by reducing the potential for aspiration (through increased swallowing evaluations) or by improving functioning (through use of rehabilitation therapy). Future studies should continue to examine the mechanisms by which neurologists may achieve better outcomes in stroke care.