Duke University, Durham, North Carolina.
Duke University, Durham, North Carolina.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):283-92. doi: 10.1016/j.jstrokecerebrovasdis.2013.02.016. Epub 2013 Mar 26.
[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.
[已更正]很少有研究检查过保险状况、治疗方法和颅内出血（ICH）住院患者的结局之间的关联。
通过对 2003 年 4 月至 2011 年 4 月期间全国前瞻性卒中登记处 Get With The Guidelines（GWTG）-Stroke 数据库的回顾性分析，我们确定了 95986 名未转院的 ICH 住院患者。保险状况分为私人/其他、医疗补助、医疗保险或无/未记录（ND）。使用患者和医院特定变量作为协变量，分析保险状况与住院结局和护理质量指标之间的关联。
保险组之间存在显著的年龄和合并症频率差异。所有保险状况组的循证护理质量指标的依从性存在差异（均<0.0001），但总体较高。在以私人保险组为参照的调整分析中，无/ND 组的护理质量指标的比值比（OR）最高（吞咽障碍筛查：OR 1.10，95%置信区间[CI]1.02-1.17，P=0.0096；卒中教育：OR 1.16，95%CI1.05-1.29，P=0.0042；康复：OR 1.25，95%CI1.08-1.44，P=0.0027）。无/ND、医疗补助和医疗保险患者的院内死亡率较高；风险调整后，无/ND 组的死亡率风险最高（OR 1.29，95%CI1.21-1.38，P<0.0001）。与私人/其他组相比，医疗保险和医疗补助患者出院时独立行走和出院回家的调整后优势较低。
GWTG-Stroke ICH 患者的死亡率、功能状态、出院去向和护理质量指标与保险状况相关，存在差异。
