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J Stroke Cerebrovasc Dis. 2014 Feb;23(2):283-92. doi: 10.1016/j.jstrokecerebrovasdis.2013.02.016. Epub 2013 Mar 26.

Insurance status and outcome after intracerebral hemorrhage: findings from Get With The Guidelines-stroke.

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Duke University, Durham, North Carolina. Electronic address:
Duke University, Durham, North Carolina.
University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.
Massachusetts General Hospital, Boston, Massachusetts.
VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
University of California, Los Angeles, California.



[corrected] Few studies have examined associations among insurance status, treatment, and outcomes in patients hospitalized for intracerebral hemorrhage (ICH).


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.


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.


GWTG-Stroke ICH patients demonstrated differences in mortality, functional status, discharge destination, and quality of care measures associated with insurance status.


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

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