Table 1.
Patient characteristics before and after neurohospitalist intervention.
| Intervention (neurohospitalist) | Control (stroke) | |||||||
|---|---|---|---|---|---|---|---|---|
| Pre (n = 1121) | Post (n = 527) | SMD a | P-value | Pre (n = 717) | Post (n = 341) | SMD a | P-value | |
| Age (%), y | ||||||||
| Median [IQR] | 50 [34, 66] | 56 [38, 69] | .18 | .001 | 75 [62, 84] | 74 [60, 85] | .05 | .52 |
| Male, % | 492 (43.9) | 262 (49.7) | .12 | .03 | 366 (51.0) | 165 (48.4) | .05 | .46 |
| Primary insurance (%) | .31 | <.001 | .28 | <.001 | ||||
| Medicare | 363 (32.4) | 218 (41.4) | 467 (65.1) | 213 (62.5) | ||||
| Medicaid/Medi-Cal | 167 (14.9) | 84 (15.9) | 58 (8.1) | 52 (15.2) | ||||
| Private | 525 (46.8) | 219 (41.6) | 163 (22.7) | 72 (21.1) | ||||
| Other | 66 (5.9) | 6 (1.1) | 29 (4.0) | 4 (1.2) | ||||
| Charlson Comorbidity Index | .38 | <.001 | .79 | <.001 | ||||
| 0 (none) | 668 (59.6) | 227 (43.1) | 4 (.6) | 5 (1.5) | ||||
| 1-2 (mild) | 330 (29.4) | 185 (35.1) | 478 (66.7) | 103 (30.2) | ||||
| 3-4 (moderate) | 80 (7.1) | 69 (13.1) | 171 (23.8) | 165 (48.4) | ||||
| >=5 (severe) | 43 (3.8) | 46 (8.7) | 64 (8.9) | 68 (19.9) | ||||
| Median [IQR] | 0 [0,1] | 1 [0, 2] | .35 | <.001 | 2 [1, 3] | 3 [2, 4] | .66 | <.001 |
| Top DRG b (%) | .42 | <.001 | .86 | <.001 | ||||
| Seizures | 188 (16.8) | 96 (18.2) | ||||||
| Degenerative disorders | 80 (7.1) | 60 (11.4) | ||||||
| Nonbacterial CNS infections excluding viral meningitis | 46 (4.1) | 52 (9.9) | ||||||
| Nervous system neoplasms | 81 (7.2) | 41 (7.8) | ||||||
| MS or Cerebellar ataxia | 75 (6.7) | 27 (5.1) | ||||||
| Other diseases of nervous system | 52 (4.6) | 27 (5.1) | ||||||
| Bacterial Tb of nervous system | 49 (4.4) | 25 (4.7) | ||||||
| Neurologic eye disease | 37 (3.3) | 24 (4.6) | ||||||
| Cranial or Peripheral nerve | 47 (4.2) | 20 (3.8) | ||||||
| Headache | 115 (10.3) | 17 (3.2) | ||||||
| ICH or stroke | 639 (89.1) | 269 (78.9) | ||||||
| Acute stroke with thrombolytic | 8 (1.1) | 32 (9.4) | ||||||
| TIA | 40 (5.6) | 10 (2.9) | ||||||
| Case Mix Index (CMI) | ||||||||
| Mean (sd) | 1.1 (.6) | 1.4 (.9) | .43 | <.001 | 1.1 (.4) | 1.4 (.5) | .60 | <.001 |
| APR DRG (%) | .46 | <.001 | .58 | <.001 | ||||
| Extreme | 34 (3.0) | 46 (8.7) | 22 (3.1) | 40 (11.7) | ||||
| Major | 270 (24.1) | 199 (37.8) | 191 (26.6) | 128 (37.5) | ||||
| Moderate | 510 (45.5) | 202 (38.3) | 379 (52.9) | 159 (46.6) | ||||
| Minor | 302 (26.9) | 78 (14.8) | 119 (16.6) | 14 (4.1) | ||||
| Missing | 5 (.4) | 2 (.4) | 6 (.8) | 0 (.0) | ||||
| Weight, mean (sd) | .9 (.7) | 1.0 (.8) | .21 | <.001 | 1.0 (.4) | 1.2 (.6) | .46 | <.001 |
| Admission source (%) | .42 | <.001 | .24 | .006 | ||||
| Hospital transfers | 193 (17.2) | 92 (17.5) | 105 (14.6) | 73 (21.4) | ||||
| Emergency/trauma | 700 (62.4) | 400 (75.9) | 592 (82.6) | 288 (78.0) | ||||
| Clinic/direct admit | 225 (20.1) | 35 (6.6) | 18 (2.5) | 2 (.6) | ||||
| Other | 3 (.3) | 0 (.0) | 2 (.3) | 0 (.0) | ||||
| Discharge disposition (%) | .37 | <.001 | .43 | <.001 | ||||
| Home (routine/with care) | 889 (79.3) | 337 (63.9) | 471 (65.7) | 162 (47.5) | ||||
| Other acute care facility/hospital | 97 (8.7) | 88 (16.7) | 74 (10.3) | 77 (22.6) | ||||
| Skilled nursing facility (SNF) | 93 (8.3) | 79 (15.6) | 116 (16.2) | 71(20.8) | ||||
| Hospice | 30 (2.7) | 20 (3.8) | 31 (4.3) | 22 (6.5) | ||||
| In-hospital death | 4 (.4) | 2 (.4) | 17 (2.4) | 7 (2.1) | ||||
SMD: standardized mean difference; IQR: interquartile range; DRG: diagnosis-related group, CNS: central nervous system; MS: multiple sclerosis; Tb: tuberculosis; ICH: intracranial hemorrhage; APR-DRG: 3M™ All Patients Refined Diagnosis-Related Groups; SNF: skilled nursing facility.
aThe higher the SMD, the greater the magnitude of difference between the two groups. Cohen offered the following guidelines for interpreting the magnitude of the SMD: small, SMD = .2; medium, SMD = .5; and large, SMD = .8.19,20
bRepresentative diagnoses include (see Table e-1): Degenerative disorders—myasthenia gravis, amyotrophic lateral sclerosis, Parkinson’s disease, Alzheimer’s dementia, and dementia with Lewy bodies; nonbacterial CNS infections—viral encephalitis, fungal meningitis, acute disseminated encephalomyelitis, transverse myelitis, and autoimmune encephalitis; bacterial Tb of the nervous system—Guillain-Barre syndrome and intracranial abscess