Mr. James D. Rhodes (not pictured), program director, and Dr. Suzanne E. Judd, associate professor, in the department of biostatistics, and Dr. Meredith Kilgore, professor and chair in the department of health care organization and policy, at the University of Alabama at Birmingham — in collaboration with lead author Dr. David L. Roth, previously a professor in UAB’s Department of Biostatistics and currently a professor in the Division of Gerontology and Geriatric Medicine at Johns Hopkins University — recently conducted a study to analyze Medicare claims for utilization of health care after patients’ discharge from the hospital following ischemic stroke to investigate gender and/or racial differences in outcomes, as well as to determine any factors that may reduce subsequent cost for care.
“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 versus White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver,” report the researchers.
After adjusting for covariates and acute stroke severity, the team found that during the post-acute care period men were less likely than women to receive healthcare at home or to seek treatment at a hospital emergency department. Also during that time, study subjects who had a co-residing caregiver experienced shorter lengths of stay in the hospital in addition to a reduced number of visits to their primary care physician and/or emergency department. Results also indicate that among patients receiving home healthcare, Whites had fewer visits than African-Americans.
The investigators concluded that “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.”
“Medicare Claims Indicators of Healthcare Utilization Differences after Hospitalization for Ischemic Stroke: Race, Gender, and Caregiving Effects” was published online in July in the International Journal of Stroke.