Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects

doi:10.1177/1747493016660095

. 2016 Oct;11(8):928-934.

doi: 10.1177/1747493016660095. Epub 2016 Jul 21.

Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects

David L Roth¹, Orla C Sheehan¹, Jin Huang¹, James D Rhodes², Suzanne E Judd², Meredith Kilgore³, Brett Kissela⁴, Janet Prvu Bettger⁵, William E Haley⁶

Affiliations

¹ 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
² 2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
³ 3 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ 4 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.
⁵ 5 Duke Clinical Research Institute, Duke University, Durham, NC, USA.
⁶ 6 School of Aging Studies, University of South Florida, Tampa, FL, USA.

PMID: 27435204
PMCID: PMC5518936
DOI: 10.1177/1747493016660095

Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects

David L Roth et al. Int J Stroke. 2016 Oct.

. 2016 Oct;11(8):928-934.

doi: 10.1177/1747493016660095. Epub 2016 Jul 21.

Authors

David L Roth¹, Orla C Sheehan¹, Jin Huang¹, James D Rhodes², Suzanne E Judd², Meredith Kilgore³, Brett Kissela⁴, Janet Prvu Bettger⁵, William E Haley⁶

Affiliations

¹ 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
² 2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
³ 3 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ 4 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.
⁵ 5 Duke Clinical Research Institute, Duke University, Durham, NC, USA.
⁶ 6 School of Aging Studies, University of South Florida, Tampa, FL, USA.

PMID: 27435204
PMCID: PMC5518936
DOI: 10.1177/1747493016660095

Abstract

Background Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs. Aim To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a US population-based sample. Methods Claims were examined over a six-month period after hospitalization for 279 ischemic stroke survivors 65 years or older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Statistical analyses examined differences in post-acute healthcare utilization, adjusted for pre-stroke utilization, as a function of race (African-American vs. White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver. Results After adjusting for covariates, women were more likely than men to receive home health care and to use emergency department services during the post-acute care period. These effects were maintained even after further adjustment for acute stroke severity. African-Americans had more home health care visits than Whites among patients who received some home health care. Having a co-residing caregiver was associated with reduced acute hospitalization length of stay and fewer post-acute emergency department and primary care physician visits. Conclusions Underutilization of healthcare after stroke does not appear to explain poorer long-term stroke outcomes for women and African-Americans in this epidemiologically-derived sample. Caregiver availability may contribute to reduced formal care and cost during the post-acute period.

Keywords: Medicare; Stroke; caregiving; epidemiology; healthcare utilization; population-based.

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Figures

**Figure 1**
Timeline of Pre-Stroke, Acute Stroke, and Post-Stroke Periods.

**Figure 2**
Flowchart of Participant Exclusions.

See this image and copyright information in PMC

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References

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1. Burke JF, Freedman VA, Lisabeth LD, Brown DL, Haggins A, Skolarus LE. Racial differences in disability after stroke. Neurology. 2014;83:390–397. - PMC - PubMed
1. Roth DL, Haley WE, Clay OJ, et al. Race and gender differences in one-year stroke outcomes for community-dwelling stroke survivors with family caregivers. Stroke. 2011;42:626–631. - PMC - PubMed
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[1] Bhandari VK, Kushel M, Price L, Schillinger D. Racial disparities in outcomes of inpatient stroke rehabilitation. Arch Phys Med Rehabil. 2005;86:2081–2086. - PubMed

[2] Bhandari VK, Kushel M, Price L, Schillinger D. Racial disparities in outcomes of inpatient stroke rehabilitation. Arch Phys Med Rehabil. 2005;86:2081–2086. - PubMed

[3] Burke JF, Freedman VA, Lisabeth LD, Brown DL, Haggins A, Skolarus LE. Racial differences in disability after stroke. Neurology. 2014;83:390–397. - PMC - PubMed

[4] Burke JF, Freedman VA, Lisabeth LD, Brown DL, Haggins A, Skolarus LE. Racial differences in disability after stroke. Neurology. 2014;83:390–397. - PMC - PubMed

[5] Roth DL, Haley WE, Clay OJ, et al. Race and gender differences in one-year stroke outcomes for community-dwelling stroke survivors with family caregivers. Stroke. 2011;42:626–631. - PMC - PubMed

[6] Roth DL, Haley WE, Clay OJ, et al. Race and gender differences in one-year stroke outcomes for community-dwelling stroke survivors with family caregivers. Stroke. 2011;42:626–631. - PMC - PubMed

[7] Stansbury JP, Jia H, Williams LS, Vogel WB, Duncan PW. Ethnic disparities in stroke: epidemiology, acute care, and postacute outcomes. Stroke. 2005;36:374–386. 2005. - PubMed

[8] Stansbury JP, Jia H, Williams LS, Vogel WB, Duncan PW. Ethnic disparities in stroke: epidemiology, acute care, and postacute outcomes. Stroke. 2005;36:374–386. 2005. - PubMed

[9] Fukuda M, Kanda T, Kamide N, Akutsu T, Sakai F. Gender differences in long-term functional outcome after first-ever ischemic stroke. Intern Med. 2009;48:967–973. - PubMed

[10] Fukuda M, Kanda T, Kamide N, Akutsu T, Sakai F. Gender differences in long-term functional outcome after first-ever ischemic stroke. Intern Med. 2009;48:967–973. - PubMed

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Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects

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Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects

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