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Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke.
J Am Heart Assoc. 2016 11 14; 5(11)JA

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 in-hospital mortality differ by patient insurance status.

Authors+Show Affiliations

Section of Emergency Medicine, Baylor College of Medicine, Houston, TX medford.davis@gmail.com.Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA.Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX.Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Department of Cardiology, Duke University Medical Center, Durham, NC.Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Department of Neurology, Duke University Medical Center, Durham, NC.Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27930356

Citation

Medford-Davis, Laura N., et al. "Impact of Insurance Status On Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With the Guidelines-Stroke." Journal of the American Heart Association, vol. 5, no. 11, 2016.
Medford-Davis LN, Fonarow GC, Bhatt DL, et al. Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke. J Am Heart Assoc. 2016;5(11).
Medford-Davis, L. N., Fonarow, G. C., Bhatt, D. L., Xu, H., Smith, E. E., Suter, R., Peterson, E. D., Xian, Y., Matsouaka, R. A., & Schwamm, L. H. (2016). Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke. Journal of the American Heart Association, 5(11).
Medford-Davis LN, et al. Impact of Insurance Status On Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With the Guidelines-Stroke. J Am Heart Assoc. 2016 11 14;5(11) PubMed PMID: 27930356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke. AU - Medford-Davis,Laura N, AU - Fonarow,Gregg C, 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, Y1 - 2016/11/14/ PY - 2016/12/9/entrez PY - 2016/12/9/pubmed PY - 2017/12/21/medline KW - health outcomes KW - health policy KW - health services research KW - insurance KW - stroke, ischemic JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 5 IS - 11 N2 - 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 in-hospital mortality differ by patient insurance status. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/27930356/Impact_of_Insurance_Status_on_Outcomes_and_Use_of_Rehabilitation_Services_in_Acute_Ischemic_Stroke:_Findings_From_Get_With_The_Guidelines_Stroke_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.116.004282?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -