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Effect of insurance status on postacute care among working age stroke survivors.
Neurology. 2012 May 15; 78(20):1590-5.Neur

Abstract

OBJECTIVE

Utilization of postacute care is associated with improved poststroke outcomes. However, more than 20% of American adults under age 65 are uninsured. We sought to determine whether insurance status is associated with utilization and intensity of institutional postacute care among working age stroke survivors.

METHODS

A retrospective cross-sectional study of ischemic stroke survivors under age 65 from the 2004-2006 Nationwide Inpatient Sample was conducted. Hierarchical logistic regression models controlling for patient and hospital-level factors were used. The primary outcome was utilization of any institutional postacute care (inpatient rehabilitation or skilled nursing facilities) following hospital admission for ischemic stroke. Intensity of rehabilitation was explored by comparing utilization of inpatient rehabilitation facilities and skilled nursing facilities.

RESULTS

Of the 33,917 working age stroke survivors, 19.3% were uninsured, 19.8% were Medicaid enrollees, and 22.8% were discharged to institutional postacute care. Compared to those privately insured, uninsured stroke survivors were less likely (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.47-0.59) while stroke survivors with Medicaid were more likely to utilize any institutional postacute care (AOR = 1.40, 95% CI 1.27-1.54). Among stroke survivors who utilized institutional postacute care, uninsured (AOR = 0.48, 95% CI 0.36-0.64) and Medicaid stroke survivors (AOR = 0.27, 95% CI 0.23-0.33) were less likely to utilize an inpatient rehabilitation facility than a skilled nursing facility compared to privately insured stroke survivors.

CONCLUSIONS

Insurance status among working age acute stroke survivors is independently associated with utilization and intensity of institutional postacute care. This may explain differences in poststroke outcomes among uninsured and Medicaid stroke survivors compared to the privately insured.

Authors+Show Affiliations

Stroke Program, University of Michigan Medical School, Ann Arbor, USA. lerusche@umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22551730

Citation

Skolarus, L E., et al. "Effect of Insurance Status On Postacute Care Among Working Age Stroke Survivors." Neurology, vol. 78, no. 20, 2012, pp. 1590-5.
Skolarus LE, Meurer WJ, Burke JF, et al. Effect of insurance status on postacute care among working age stroke survivors. Neurology. 2012;78(20):1590-5.
Skolarus, L. E., Meurer, W. J., Burke, J. F., Prvu Bettger, J., & Lisabeth, L. D. (2012). Effect of insurance status on postacute care among working age stroke survivors. Neurology, 78(20), 1590-5. https://doi.org/10.1212/WNL.0b013e3182563bf5
Skolarus LE, et al. Effect of Insurance Status On Postacute Care Among Working Age Stroke Survivors. Neurology. 2012 May 15;78(20):1590-5. PubMed PMID: 22551730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of insurance status on postacute care among working age stroke survivors. AU - Skolarus,L E, AU - Meurer,W J, AU - Burke,J F, AU - Prvu Bettger,J, AU - Lisabeth,L D, Y1 - 2012/05/02/ PY - 2012/5/4/entrez PY - 2012/5/4/pubmed PY - 2012/7/10/medline SP - 1590 EP - 5 JF - Neurology JO - Neurology VL - 78 IS - 20 N2 - OBJECTIVE: Utilization of postacute care is associated with improved poststroke outcomes. However, more than 20% of American adults under age 65 are uninsured. We sought to determine whether insurance status is associated with utilization and intensity of institutional postacute care among working age stroke survivors. METHODS: A retrospective cross-sectional study of ischemic stroke survivors under age 65 from the 2004-2006 Nationwide Inpatient Sample was conducted. Hierarchical logistic regression models controlling for patient and hospital-level factors were used. The primary outcome was utilization of any institutional postacute care (inpatient rehabilitation or skilled nursing facilities) following hospital admission for ischemic stroke. Intensity of rehabilitation was explored by comparing utilization of inpatient rehabilitation facilities and skilled nursing facilities. RESULTS: Of the 33,917 working age stroke survivors, 19.3% were uninsured, 19.8% were Medicaid enrollees, and 22.8% were discharged to institutional postacute care. Compared to those privately insured, uninsured stroke survivors were less likely (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.47-0.59) while stroke survivors with Medicaid were more likely to utilize any institutional postacute care (AOR = 1.40, 95% CI 1.27-1.54). Among stroke survivors who utilized institutional postacute care, uninsured (AOR = 0.48, 95% CI 0.36-0.64) and Medicaid stroke survivors (AOR = 0.27, 95% CI 0.23-0.33) were less likely to utilize an inpatient rehabilitation facility than a skilled nursing facility compared to privately insured stroke survivors. CONCLUSIONS: Insurance status among working age acute stroke survivors is independently associated with utilization and intensity of institutional postacute care. This may explain differences in poststroke outcomes among uninsured and Medicaid stroke survivors compared to the privately insured. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/22551730/Effect_of_insurance_status_on_postacute_care_among_working_age_stroke_survivors_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=22551730 DB - PRIME DP - Unbound Medicine ER -