title: Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects.
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.
authors.affiliation: 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.affiliation: 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Orla C
authors.initials: OC
authors.lastname: Sheehan
authors.affiliation: 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Huang
authors.affiliation: 2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Rhodes
authors.affiliation: 2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: 3 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Kilgore
authors.affiliation: 4 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Kissela
authors.affiliation: 5 Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: 6 School of Aging Studies, University of South Florida, Tampa, FL, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Haley
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000628:therapy*; D017028:Caregivers; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D010342:Patient Acceptance of Health Care; D044469:Racial Groups; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*; D014481:United States
keywords: Medicare; Stroke; caregiving; epidemiology; healthcare utilization; population-based