Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.
Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.
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DOI：
10.1161/strokeaha.114.005882
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发表时间：
2014-08
期刊：
影响因子：
8.3
通讯作者：
Lisabeth LD
中科院分区：
文献类型：
--
作者：
Skolarus LE;Burke JF;Morgenstern LB;Meurer WJ;Adelman EE;Kerber KA;Callaghan BC;Lisabeth LD
Post-stroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among stroke patients. Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample (NIS). Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tPA use, state Medicaid IRF coverage and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) out of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (p for interaction <0.01). Compared to Medicaid stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF 11.6% ( 95% CI, 8.5-14.7%) versus 19.5% (95% CI, 18.3-20.8%), p<0.01 after full adjustment. State Medicaid coverage of IRFs is associated with IRF utilization among stroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for post-stroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted.
