Medicare and VA Patients Have More Inpatient Complications and Less Neuroimaging Than Uninsured Patients (P2.139)

OBJECTIVE: We sought to compare differences by various types of insurance coverage for in-hospital care of stroke patients. BACKGROUND: Insurance coverage is being fundamentally altered by healthcare reform. Previous studies have shown that insurance coverage can affect patient outcomes. However, there is limited data about the impact of variable insurance coverage on management of stroke patients in the hospital. DESIGN/METHODS: We compared the in-hospital care of patients with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) treated at Tulane Medical Center (TMC) based upon patients’ form of insurance coverage. Patients admitted to our stroke center (07/08-06/13) were analyzed using a prospectively collected stroke registry. Patients were excluded if they had no documented insurance type. Univariate and multivariate analyses were performed for insurance type based on in-hospital variables. RESULTS: Among all insurance types, VA patients had the lowest IV tPA rates with Medicare and uninsured patients having the highest (11.2% vs. 25.5% and 24.5%, p=0.002). Uninsured patients had the lowest in-patient complication rate compared to Medicare having one of the highest (11.76% vs. 23.30%, p<0.001). By imaging, uninsured patients compared to Medicare and VA patients had higher order rates for MRA (58.00% vs. 55.60% and 40.96%, p<0.001), and neck CTA (50.57% vs. 42.04% and 35.58%, p=0.002). Uninsured patients were twice as likely to have a neurosurgical procedure (OR=1.94, 95% CI 1.1677-3.2220, p=0.011) and 35% less likely to have inpatient complications (OR=0.65, 95% CI 0.4835-0.8831, p=0.006). CONCLUSIONS: Our results indicate that uninsured patients receive more neuroimaging and experience fewer inpatient complications than patients with other insurance types. Further studies are warranted to explain why these differences in coverage impact clinical care to maintain equitable care appropriate for the degree of clinical severity for stroke patients. Disclosure: Dr. Baranwal has nothing to disclose. Dr. Monlezun, Jr has nothing to disclose. Dr. Ryan has nothing to disclose. Dr. Pineda has nothing to disclose. Dr. Shaban has nothing to disclose. Dr. George has received research support from Tulane University School of Medicine. Dr. El Khoury has nothing to disclose. Dr. Martin-Schild has nothing to disclose.