Hospital And Demographic Characteristics Associated With Availability Of Inpatient Neurological Services

Objective: To determine nationwide availability and factors associated with inpatient neurological services.Background: Numerous studies have shown that availability of neurological expertise improves outcomes among patients with neurological disorders. The proportion of hospitals with availability of neurological consultation, and factors associated with availability of those services, remains unknown.Design/Methods: Using the 2011 American Hospital Association survey we determined proportion of hospitals that provided inpatient potential neurological services. Demographic and household data from the 2010 national census for population and survey results were utilized to determine regional factors associated with availability of inpatient neurologic services. The association (rate ratio) was estimated using Poisson regression. Hospitals lacking emergency departments or with a bed size of less than 25 beds were excluded to focus on acute care facilities with the potential to have subspecialty services.Results: Of the 3969 hospitals that completed the survey, 3124 fulfilled study criteria, of which 2017 (65[percnt]) provided inpatient neurological services. Hospitals with The Joint Commission accreditation were 1.35 times more likely to provide (95[percnt] CI: 1.16-1.57) to have inpatient neurological services to those without accreditation. Compared to small hospitals (bed size 25-36), large hospitals (bed size 246-2264) were 4.53 times more likely to provide (95[percnt] CI: 2.79-7.35) inpatient neurological services. Hospitals that were the sole community provider or were non-federal governmental hospitals had a lower probability of providing inpatient neurological services with rate ratio of 0.65 (95[percnt] CI: 0.5-0.84) and 0.81 (95[percnt] CI: 0.7-0.94), respectively.Conclusions: Approximately two-thirds of hospitals in this nationwide survey provided hospital-based neurological services. Larger hospitals and those with The Joint Commission accreditation were more likely to provide neurological services, whereas small hospitals, sole community providers, and governmental hospitals were less likely to provide them. A potential area of improvement is to increase neurological services at governmental hospitals, which may improve clinical outcomes. Disclosure: Dr. Razmara has nothing to disclose. Dr. Cen has nothing to disclose. Dr. Dutta has nothing to disclose. Dr. Mack has nothing to disclose. Dr. Towfighi has nothing to disclose. Dr. Sanossian has recieved personal compensation for activities with Covidien Inc., serving on the clinical events committee for the SWIFT-PRIME clinical trial.