Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States.
Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States.
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DOI：
10.1371/journal.pone.0292546
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Lichtman, Judith H.
中科院分区：
文献类型：
--
作者：
Leifheit, Erica C.;Wang, Yun;Goldstein, Larry B.;Lichtman, Judith H.
医疗补助是为资产有限的低收入美国医疗保险受益人提供的安全网。大约有770万年龄≥65岁的美国人依靠医疗保险和医疗补助的组合来获得关键的医疗服务，但很少有人知道这些患者在中风后的结果是否比单独使用医疗保险的患者更差。我们比较了双重医疗保险-医疗补助资格和缺血性中风住院的地理模式，并检查这些双重资格受益人的中风后结果是否比仅接受医疗保险的受益人更差。我们确定了2014年从美国急性护理医院出院的年龄≥65岁的按服务付费医疗保险受益人，他们的主要诊断为缺血性卒中。医疗保险受益人与≥1个月的医疗补助覆盖被认为是双重资格。我们绘制了风险标准化中风住院率和双重资格受益人的百分比。混合模型和考克斯回归用于评估双重合格状态与卒中后1年内结局之间的关系，调整人口统计学和临床因素。在国家一级，12.5%的受益人具有双重资格。双合格率最高的是缅因州、阿拉斯加和美国南部，而中风住院率最高的是南部和部分中西部地区（Pearson's r = 0.469，p<0.001）。在254，902例因卒中住院的患者中，17.4%的患者具有双重资格。在校正分析中，双重合格患者在30天内全因再入院的风险更大（风险比1.06，95%置信区间[CI] 1.03-1.09）和1年（风险比1.03，95% CI 1.02-1.05），1年内死亡的几率更大（比值比1.20，95% CI 1.17-1.23）;住院或30天死亡率无差异。即使在合并症调整后，双重合格的卒中患者的再入院率和长期死亡率也高于其他患者。需要更好地了解导致这些不良结果的因素。
Medicaid serves as a safety net for low-income US Medicare beneficiaries with limited assets. Approximately 7.7 million Americans aged ≥65 years rely on a combination of Medicare and Medicaid to obtain critical medical services, yet little is known about whether these patients have worse outcomes after stroke than patients with Medicare alone. We compared geographic patterns in dual Medicare-Medicaid eligibility and ischemic stroke hospitalizations and examined whether these dual-eligible beneficiaries had worse post-stroke outcomes than those with Medicare alone. We identified fee-for-service Medicare beneficiaries aged ≥65 years who were discharged from US acute-care hospitals with a principal diagnosis of ischemic stroke in 2014. Medicare beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We mapped risk-standardized stroke hospitalization rates and percentages of beneficiaries with dual eligibility. Mixed models and Cox regression were used to evaluate relationships between dual-eligible status and outcomes up to 1 year after stroke, adjusting for demographic and clinical factors. At the national level, 12.5% of beneficiaries were dual eligible. Dual-eligible rates were highest in Maine, Alaska, and the southern half of the United States, whereas stroke hospitalization rates were highest in the South and parts of the Midwest (Pearson’s r = 0.469, p<0.001). Among 254,902 patients hospitalized for stroke, 17.4% were dual eligible. In adjusted analyses, dual-eligible patients had greater risk of all-cause readmission within 30 days (hazard ratio 1.06, 95% confidence interval [CI] 1.03–1.09) and 1 year (hazard ratio 1.03, 95% CI 1.02–1.05) and had greater odds of death within 1 year (odds ratio 1.20, 95% CI 1.17–1.23) when compared with Medicare-only patients; there was no difference in in-hospital or 30-day mortality. Dual-eligible stroke patients had higher readmissions and long-term mortality than other patients, even after comorbidity adjustment. A better understanding of the factors contributing to these poorer outcomes is needed.
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影响因子：
9.7
作者：
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通讯作者：
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影响因子：
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