2019 年 1 巻 3 号 p. 86-94
BACKGROUND
The association between physician specialty and stroke mortality remains controversial. The present study evaluated the effectiveness of admission to a hospital with neurologic specialist staffing on 30 day in-hospital mortality after cerebral infarction, controlling for measured and unmeasured hospital and patient characteristics.
METHODS
The study involved 56,866 patients with cerebral infarction who were hospitalized within 1 day after onset between July 1, 2010 and March 31, 2012. Participants were identified using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institution and Hospital Report data and Survey of Physicians data. Well-staffed hospitals were defined as those with ≥3 board-certified neurologic specialists. Poorly-staffed hospitals were those with <3 board-certified neurologic specialists. The association between neurologic specialist staffing and 30-day in-hospital mortality was examined using a generalized estimation equations logistic regression model. Ordinary least square model and two-stage least square model using differential distance to hospitals as an instrumental variable were used for sensitivity analyses.
RESULTS
After adjusting for patient severity and hospital characteristics, 30-day in-hospital mortality at well-staffed hospitals was significantly lower than that at poorly-staffed hospitals (odds ratio, 0.89; 95% confidence interval, 0.79–0.99; P = 0.040). Hausman specification test suggested that admission to well-staffed hospital was exogenous. Ordinary least square model showed 30-day in-hospital mortality at well-staffed hospitals was significantly lower than that at poorly-staffed hospitals (risk difference, −0.6%; 95% confidence interval, −1.2% to −0.0%; P = 0. 044).
CONCLUSIONS
Hospitals with ≥3 neurologic specialists were associated with reduced 30-day in-hospital mortality for cerebral infarction.
