Engel-Nitz et al (excluding nursing homes or skilled nursing facilities), but it is possible that some acute rehabilitation hospitals may have been included in this measure. Results of this analysis are primarily applicable to managed care settings. The plans used for analysis, however, are discounted fee-for-service plans rather than capitated or gatekeeper models. They include a wide geographic distribution across the United States and thus provide the capability for generalization to managed care populations on a national level. However, these results cannot be extrapolated to represent the association between stroke and clinical and cost outcomes in a solely Medicare patient population or among the uninsured. As discussed previously, the inability to identify costs after patients disenrolled from the health plan also suggests that this finding may somewhat under-represent costs for ischemic stroke patients; health care systems in which the payers are responsible for patients’ costs throughout their life span may face a higher cost burden. In addition, these results may not be generalizable to cardioembolic stroke; this analysis was limited to patients without AF or mitral valve abnormalities, as the intense management required for AF or valve abnormalities may result in differ- ent clinical outcomes, utilization patterns, and costs for this subset of patients than those experienced by patients with noncardioembolic stroke. The findings of this study highlight the need for an urgent approach to diagnosis and treatment in order to prevent noncardioembolic ischemic stroke and stoke recurrence. 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