OBJECTIVE: to study patterns of medical resource utilization among VA patients following admission to VA hospitals for acute ischemic stroke. METHODS: All VA patients were identified with a first-listed live discharge diagnosis of acute ischemic stroke between 1991 and 1997. The frequency and type of re-admissions, total bed section days, and of outpatient clinic visits was measured. RESULTS: A total of 49,101 patients were identified. Mean age of the predominantly male (98.2%) cohort was 67.8 years and 72.5% were Caucasian. Over 48% of patients were re-hospitalized, and 13% of these re-admissions were for recurrent stroke. There were an average of 3.3 re-admissions and the mean time to readmission was 0.9 years. Readmitted patients spent most days in rehabilitation wards (26.8 days), followed bygeneral/acute medicine wards (22.5 days), surgery (15.1 days). neurology (14.9 days), and cardiology (8.5 days). Thirty-five percent of outpatient medical clinic visits were to specialty clinics and 41% of these visits were to neurology followed by cardiology (22%) and Coumadin clinics (21%). CONCLUSIONS: Hospitalization for recurrent stroke is high among VA stroke patients and much of the inpatient and outpatient resource utilization is associated with stroke rehabilitation and neurologic care. Efforts should focus on innovations in acute stroke treatment to improve the functional status of these patients at the time of the index admission and reduce the incidence of subsequent adverse events.