TY - JOUR
T1 - Insurance status and outcome after intracerebral hemorrhage
T2 - Findings from get with the Guidelines-stroke
AU - James, Michael L.
AU - Grau-Sepulveda, Maria V.
AU - Olson, Daiwai M.
AU - Smith, Eric E.
AU - Hernandez, Adrian F.
AU - Peterson, Eric D.
AU - Schwamm, Lee H.
AU - Bhatt, Deepak L.
AU - Fonarow, Gregg C.
N1 - Funding Information:
The GWTG–Stroke program is provided by the American Heart Association/American Stroke Association and is currently supported in part by a charitable contribution from Ortho-McNeil . GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim and Merck , Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership , and the American Heart Association Pharmaceutical Round Table . This article was also supported by the American Heart Association–Scientist Development Grant (M.L.J.).
PY - 2014/2
Y1 - 2014/2
N2 - Backgound: Few studies have examined associations among insurance status, treatment, and outcomes in patients hospitalized for intracerebral hemorrhage (ICH). Methods: Through retrospective analyses of the Get With The Guidelines (GWTG)-Stroke database, a national prospective stroke registry, from April 2003 to April 2011, we identified 95,986 nontransferred subjects hospitalized with ICH. Insurance status was categorized as Private/Other, Medicaid, Medicare, or None/Not Documented (ND). Associations between insurance status and in-hospital outcomes and quality of care measures were analyzed using patient- and hospital-specific variables as covariates. Results: There were significant differences in age and frequency of comorbid conditions by insurance group. Compliance with evidence-based quality of care indicators varied across all insurance status groups (P <.0001) but was generally high. In adjusted analysis with the Private insurance group as reference, the None/ND group most consistently demonstrated higher odds ratios (ORs) for quality of care measures (Dysphagia Screen: OR 1.10, 95% confidence interval [CI] 1.02-1.17, P =.0096; Stroke Education: OR 1.16, 95% CI 1.05-1.29, P =.0042; and Rehabilitation: OR 1.25, 95% CI 1.08-1.44, P =.0027). In-hospital mortality rates were higher for None/ND, Medicaid, and Medicare patients; after risk adjustment, the None/ND group had the highest mortality risk (OR 1.29, 95% CI 1.21-1.38, P <.0001). Medicare and Medicaid patients had lower adjusted odds for both independent ambulation at discharge and discharge to home when compared with the Private/Other group. Conclusions: GWTG-Stroke ICH patients demonstrated differences in mortality, functional status, discharge destination, and quality of care measures associated with insurance status.
AB - Backgound: Few studies have examined associations among insurance status, treatment, and outcomes in patients hospitalized for intracerebral hemorrhage (ICH). Methods: Through retrospective analyses of the Get With The Guidelines (GWTG)-Stroke database, a national prospective stroke registry, from April 2003 to April 2011, we identified 95,986 nontransferred subjects hospitalized with ICH. Insurance status was categorized as Private/Other, Medicaid, Medicare, or None/Not Documented (ND). Associations between insurance status and in-hospital outcomes and quality of care measures were analyzed using patient- and hospital-specific variables as covariates. Results: There were significant differences in age and frequency of comorbid conditions by insurance group. Compliance with evidence-based quality of care indicators varied across all insurance status groups (P <.0001) but was generally high. In adjusted analysis with the Private insurance group as reference, the None/ND group most consistently demonstrated higher odds ratios (ORs) for quality of care measures (Dysphagia Screen: OR 1.10, 95% confidence interval [CI] 1.02-1.17, P =.0096; Stroke Education: OR 1.16, 95% CI 1.05-1.29, P =.0042; and Rehabilitation: OR 1.25, 95% CI 1.08-1.44, P =.0027). In-hospital mortality rates were higher for None/ND, Medicaid, and Medicare patients; after risk adjustment, the None/ND group had the highest mortality risk (OR 1.29, 95% CI 1.21-1.38, P <.0001). Medicare and Medicaid patients had lower adjusted odds for both independent ambulation at discharge and discharge to home when compared with the Private/Other group. Conclusions: GWTG-Stroke ICH patients demonstrated differences in mortality, functional status, discharge destination, and quality of care measures associated with insurance status.
KW - Stroke
KW - cerebrovascular disorders
KW - epidemiology
KW - health care policy
KW - intracerebral hemorrhage
KW - risk factors
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U2 - 10.1016/j.jstrokecerebrovasdis.2013.02.016
DO - 10.1016/j.jstrokecerebrovasdis.2013.02.016
M3 - Article
C2 - 23537567
AN - SCOPUS:84893419649
SN - 1052-3057
VL - 23
SP - 283
EP - 292
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 2
ER -