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 Citations (Scopus)

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 2014

Fingerprint

Insurance Coverage
Cerebral Hemorrhage
Quality of Health Care
Stroke
Odds Ratio
Guidelines
Medicaid
Medicare
Confidence Intervals
Insurance
Mortality
Risk Adjustment
Deglutition Disorders
Hospital Mortality
Walking
Registries
Rehabilitation
Databases
Education

Keywords

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

ASJC Scopus subject areas

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

Cite this

Insurance status and outcome after intracerebral hemorrhage : Findings from get with the Guidelines-stroke. / James, Michael L.; Grau-Sepulveda, Maria V.; Olson, Daiwai M.; Smith, Eric E.; Hernandez, Adrian F.; Peterson, Eric D.; Schwamm, Lee H.; Bhatt, Deepak L.; Fonarow, Gregg C.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 2, 02.2014, p. 283-292.

Research output: Contribution to journalArticle

James, ML, Grau-Sepulveda, MV, Olson, DM, Smith, EE, Hernandez, AF, Peterson, ED, Schwamm, LH, Bhatt, DL & Fonarow, GC 2014, 'Insurance status and outcome after intracerebral hemorrhage: Findings from get with the Guidelines-stroke', Journal of Stroke and Cerebrovascular Diseases, vol. 23, no. 2, pp. 283-292. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.02.016
James, Michael L. ; Grau-Sepulveda, Maria V. ; Olson, Daiwai M. ; Smith, Eric E. ; Hernandez, Adrian F. ; Peterson, Eric D. ; Schwamm, Lee H. ; Bhatt, Deepak L. ; Fonarow, Gregg C. / Insurance status and outcome after intracerebral hemorrhage : Findings from get with the Guidelines-stroke. In: Journal of Stroke and Cerebrovascular Diseases. 2014 ; Vol. 23, No. 2. pp. 283-292.
@article{398b5f575dcd41f2add9ea6531d8a4d8,
title = "Insurance status and outcome after intracerebral hemorrhage: Findings from get with the Guidelines-stroke",
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.",
keywords = "cerebrovascular disorders, epidemiology, health care policy, intracerebral hemorrhage, risk factors, Stroke",
author = "James, {Michael L.} and Grau-Sepulveda, {Maria V.} and Olson, {Daiwai M.} and Smith, {Eric E.} and Hernandez, {Adrian F.} and Peterson, {Eric D.} and Schwamm, {Lee H.} and Bhatt, {Deepak L.} and Fonarow, {Gregg C.}",
year = "2014",
month = "2",
doi = "10.1016/j.jstrokecerebrovasdis.2013.02.016",
language = "English (US)",
volume = "23",
pages = "283--292",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "2",

}

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.

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 - cerebrovascular disorders

KW - epidemiology

KW - health care policy

KW - intracerebral hemorrhage

KW - risk factors

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=84893419649&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893419649&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2013.02.016

DO - 10.1016/j.jstrokecerebrovasdis.2013.02.016

M3 - Article

C2 - 23537567

AN - SCOPUS:84893419649

VL - 23

SP - 283

EP - 292

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 2

ER -