Impact of Insurance Status on Outcomes and use of Rehabilitation Services in Acute Ischemic Stroke

Findings From Get With The Guidelines-Stroke

Laura N. Medford-Davis, Gregg C. Fonarow, Deepak L. Bhatt, Haolin Xu, Eric E. Smith, Robert Suter, Eric D. Peterson, Ying Xian, Roland A. Matsouaka, Lee H. Schwamm

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background-Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. Methods and Results--Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65 years, OR 1.33 [95% CI 1.22-1.45]; ≥65 years OR 1.54 [95% CI 1.34-1.75]), and among survivors, were less likely to go to inpatient rehab (<65 OR 0.63 [95% CI 0.6-0.67]; ≥65 OR 0.56 [95% CI 0.5-0.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65 years OR 2.08 [CI 1.96-2.2]; OR 2.01 [95% CI 1.91-2.13]; ≥65 years OR 1.1 [95% CI 1.07-1.13]; OR 1.41 [95% CI 1.35-1.46]). Conclusions--Preventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and inhospital mortality differ by patient insurance status.

Original languageEnglish (US)
Article numbere004282
JournalJournal of the American Heart Association
Volume5
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Insurance Coverage
Stroke
Guidelines
Hospital Mortality
Insurance
Skilled Nursing Facilities
Preventive Medicine
Ambulances
Quality of Health Care
Medicaid
Medicare
Survivors
Comorbidity
Inpatients
Diabetes Mellitus
Rehabilitation
Logistic Models
Cholesterol
Demography
Hypertension

Keywords

  • Health outcomes
  • Health policy
  • Health services research
  • Insurance
  • Stroke, ischemic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Insurance Status on Outcomes and use of Rehabilitation Services in Acute Ischemic Stroke : Findings From Get With The Guidelines-Stroke. / Medford-Davis, Laura N.; Fonarow, Gregg C.; Bhatt, Deepak L.; Xu, Haolin; Smith, Eric E.; Suter, Robert; Peterson, Eric D.; Xian, Ying; Matsouaka, Roland A.; Schwamm, Lee H.

In: Journal of the American Heart Association, Vol. 5, No. 11, e004282, 01.11.2016.

Research output: Contribution to journalArticle

Medford-Davis, Laura N. ; Fonarow, Gregg C. ; Bhatt, Deepak L. ; Xu, Haolin ; Smith, Eric E. ; Suter, Robert ; Peterson, Eric D. ; Xian, Ying ; Matsouaka, Roland A. ; Schwamm, Lee H. / Impact of Insurance Status on Outcomes and use of Rehabilitation Services in Acute Ischemic Stroke : Findings From Get With The Guidelines-Stroke. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 11.
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abstract = "Background-Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. Methods and Results--Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65 years, OR 1.33 [95{\%} CI 1.22-1.45]; ≥65 years OR 1.54 [95{\%} CI 1.34-1.75]), and among survivors, were less likely to go to inpatient rehab (<65 OR 0.63 [95{\%} CI 0.6-0.67]; ≥65 OR 0.56 [95{\%} CI 0.5-0.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65 years OR 2.08 [CI 1.96-2.2]; OR 2.01 [95{\%} CI 1.91-2.13]; ≥65 years OR 1.1 [95{\%} CI 1.07-1.13]; OR 1.41 [95{\%} CI 1.35-1.46]). Conclusions--Preventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and inhospital mortality differ by patient insurance status.",
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AU - Bhatt, Deepak L.

AU - Xu, Haolin

AU - Smith, Eric E.

AU - Suter, Robert

AU - Peterson, Eric D.

AU - Xian, Ying

AU - Matsouaka, Roland A.

AU - Schwamm, Lee H.

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KW - Health policy

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KW - Stroke, ischemic

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