Disparities in Outcomes Among Patients With Stroke Associated With Insurance Status

Shen, Jay J.; Washington, Elmer L.

doi:10.1161/01.str.0000257312.12989.af

Cited by 88 publications

(68 citation statements)

References 20 publications

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“…11,12,14 For example, LaPar et al 13 demonstrated that Medicaid insurance status was associated with the longest length of stay and highest total costs, whereas Medicaid and uninsured insurance status independently conferred the highest adjusted risks of mortality in patients undergoing major surgical operations. Similarly, Shen et al 15 reported that uninsured patients had a higher level of neurologic impairment, a longer average length of hospital stay, and higher mortality risk after an acute ischemic stroke. Limitations of the current study include the selection bias related to the database: only 20% of the US population is represented in the National Inpatient Sample.…”

Section: Resultsmentioning

confidence: 93%

Morbidity and mortality of radical prostatectomy differs by insurance status

Trinh

Schmitges

Sun

et al. 2011

Cancer

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BACKGROUND: Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short‐term RP outcomes. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003‐2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in‐hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors. RESULTS Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions (P < .001), higher overall postoperative complication rates (P < .001), higher rates of hospital stay above the median (P < .001), as well as higher in‐hospital mortality (P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in‐hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, P×< .001) and length of stay beyond the median (OR = 1.25, P < .001). CONCLUSIONS: Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance. Cancer 2012;. © 2011 American Cancer Society.

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Section: Resultsmentioning

confidence: 93%

Morbidity and mortality of radical prostatectomy differs by insurance status

Trinh

Schmitges

Sun

et al. 2011

Cancer

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“…6,14,[17][18][19] The NIS was used in the current study because it is the largest all-payer national database. Thus, the NIS provides a broader perspective than regional or statewide databases, and, in contrast to single-payer databases, allows the impact of many different payer types, including self-pay and no charge, to be examined.…”

Section: Advantages and Limitations To The Study Designmentioning

confidence: 99%

The impact of insurance status on outcomes after surgery for spinal metastases

Dasenbrock

Wolinsky

Sciubba

et al. 2012

Cancer

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BACKGROUND: Disparities based on insurance status in the American health care system are well established. However, to the authors' knowledge, this is the first study to evaluate variables that may explain differences based on payer type in the outcomes after surgery for spinal metastases. METHODS: Data from the Nationwide Inpatient Sample (2005)(2006)(2007)(2008) were retrospectively extracted. Patients ages 18 to 64 years who underwent surgery for spinal metastases were included. Multivariate logistic regression was performed to calculate the adjusted odds of in-hospital death and the development of a complication for Medicaid recipients and for those without insurance compared with privately insured patients. All analyses were adjusted for differences in patient age, gender, primary tumor histology, socioeconomic status, hospital bed size, and hospital teaching status. RESULTS: A total of 2157 hospital admissions were evaluated. The adjusted odds of in-hospital death were significantly higher for Medicaid recipients (crude rate: 6.5%; odds ratio [OR]

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“…3,[6][7][8]10,13,[16][17][18]20 In a recent retrospective chart review of the New Jersey Acute Stroke Registry of patients presenting with acute ischemic stroke, uninsured patients had higher mortality and longer lengths of stay than insured patients. a higher level of neurological impairment, higher mortality, and longer lengths of stay for uninsured patients.…”

Section: Discussionmentioning

confidence: 99%

Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

Fargen¹,

Neal²,

Blackburn³

et al. 2015

JNS

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OBJECT The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable analyses to determine the effects of patient variables on the probability of developing each indicator. RESULTS The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays, higher mortality, and worse outcomes than those with private insurance (p < 0.0001). CONCLUSIONS Insurance status is an independent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.

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Disparities in Outcomes Among Patients With Stroke Associated With Insurance Status

Cited by 88 publications

References 20 publications

Morbidity and mortality of radical prostatectomy differs by insurance status

Morbidity and mortality of radical prostatectomy differs by insurance status

The impact of insurance status on outcomes after surgery for spinal metastases

Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

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