Insurance status and outcome after intracerebral hemorrhage: Findings from get with the Guidelines-stroke

Michael L. James, Maria V. Grau-Sepulveda, Daiwai M. Olson, Eric E. Smith, Adrian F. Hernandez, Eric D. Peterson, Lee H. Schwamm, Deepak L. Bhatt, Gregg C. Fonarow

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)283-292
Number of pages10
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number2
DOIs
StatePublished - Feb 1 2014

Keywords

  • Stroke
  • cerebrovascular disorders
  • epidemiology
  • health care policy
  • intracerebral hemorrhage
  • risk factors

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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    James, M. L., Grau-Sepulveda, M. V., Olson, D. M., Smith, E. E., Hernandez, A. F., Peterson, E. D., Schwamm, L. H., Bhatt, D. L., & Fonarow, G. C. (2014). Insurance status and outcome after intracerebral hemorrhage: Findings from get with the Guidelines-stroke. Journal of Stroke and Cerebrovascular Diseases, 23(2), 283-292. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.02.016