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D-H Researchers: More Specialists Mean Fewer Deaths from Stroke

December 03, 2012
Lebanon, NH

  • Research in Journal of Neurosurgery shows availability of local neurologists and neurosurgeons may be important for overall likelihood of surviving stroke
  • Neurosurgeons generally concentrated in and around cities with tertiary care hospitals; large disparity in the density of neuroscience providers throughout U.S. counties
  • Study highlights the key role that specialist providers play in improving public health outcomes
Neurosurgery photo

A team of researchers at Dartmouth-Hitchcock (D-H) in Lebanon has found an association in the US between a higher density of neurologists and neurosurgeons and a decreased risk of death from stroke.

"Stroke is a leading cause of death and disability in the United States," says Atman Desai, MD, a neurosurgery resident at D-H who led the study, which was published by the Journal of Neurosurgery late last week. "Therefore, it's important on a national level to understand how that burden can be reduced."

Desai worked with neurosurgeon Perry Ball, MD, and fellow neurosurgery resident Kimon Bekelis, MD, performing a retrospective analysis of data from the Area Resource File 2009-2010. The database contains county-level information on health care facilities and their utilization and expenditures, health care professionals and their training, and socioeconomic and environmental characteristics.

In all, the researchers examined 3,141 US counties, with the primary outcome variable being the average number of deaths from cerebrovascular disease per million people for each county for the years 2004 through 2006. The primary independent variable was the density of neuroscience providers – the combined number of neurologists and neurosurgeons per million people – in 2006.

In an unadjusted analysis, Desai and colleagues found that an increase of one neuroscience provider per million people was associated with 0.71 fewer deaths due to stroke per million people. In a multivariate analysis, in which adjustments were made for county urbanicity, socioeconomic conditions and the density of general practitioners, an increase of one neurologist or neurosurgeon was associated with 0.38 fewer deaths from stroke per million people.

Notably, rural settings were associated with a significant increase in stroke-related deaths (the majority of counties studied, 2,051, were classified as rural).

Neurosurgeons are generally concentrated in and around cities that house tertiary care hospitals, so there's a large disparity in the density of neuroscience providers throughout U.S. counties, explains Desai. "Timely diagnosis and intervention depend on the immediate availability of both neurologists and neurosurgeons, and this is extremely important in stroke cases," he says.

Given the association found between the distribution of neuroscience providers and stroke-related deaths, the D-H team concludes that the availability of local neurologists and neurosurgeons may be important for the overall likelihood of surviving a stroke, and therefore specialist education and practice throughout the US should be promoted.

"The study highlights the key role that specialist providers can play in improving public health outcomes," says Desai. "While the role of generalists has quite rightly received a lot of attention, the role of specialists has received relatively little. This research adds to the ongoing discussion about the need to establish optimal manpower and resource allocation in health care."

About Dartmouth-Hitchcock

Dartmouth-Hitchcock is a national leader in patient-centered health care and building a sustainable health system. Founded in 1893, the system includes New Hampshire's only Level 1 trauma center and its only air ambulance service, as well as the Norris Cotton Cancer Center, one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the Children's Hospital at Dartmouth-Hitchcock, the state's only Children's Hospital Association-approved, comprehensive, full-service children's hospital. As an academic medical center, Dartmouth-Hitchcock provides access to nearly 1,000 primary care doctors and specialists in almost every area of medicine, as well as world-class research at the Audrey and Theodor Geisel School of Medicine at Dartmouth.

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