1426 - Evaluating the Association Between Insurance Status and 90-Day Function Outcomes in Patients After Stroke

Stroke is the leading cause of disability in the United States, yet access to and quality of rehabilitative care varies among stroke survivors. Presently, there is a gap in the literature on how insurance influences post-stroke outcomes. This study aims to assess the association among insurance types and rehabilitation outcomes. 

Design:

The retrospective cohort study analyzed discharge and 90-day outcomes from 96 stroke patients who underwent cognitive and language screening as part of a quality improvement initiative at the University of Pennsylvania. Demographics, National Institutes of Health Stroke Scale (NIHSS) scores, discharge therapy recommendations, Modified Rankin Scale (mRS) scores at discharge and at 90 days, and insurance status were collected. Statistical analysis in RStudio involved Fisher’s exact test, Kruskal-Wallis, and ordinal logistic regression to evaluate associations between insurance and outcomes. 


Results:

Among 96 patients, 72 had complete discharge data and 22 completed 90-day follow-up. In the follow-up group, 50.0% were White, 40.9% Black/African American, 4.5% Asian, and 4.5% Other; insurance included Medicare (40.9%), Medicaid (27.3%), and Private Insurance (13.6%). No association was present between insurance type and mRS at discharge (good: 0-2, poor: 3-5, p = 0.53). However, private insurance predicted better 90-day outcomes (p = 0.033, n  = 20) in comparison to the publicly insured, in which 10/15 patients had poor outcomes. Higher NIHSS at admission also predicted worse mRS at discharge (p = 0.048), whereas age and stroke type were not significant. 

Conclusions:

Insurance status could be evaluated as an influential factor on rehabilitation outcomes. Differences in 90-day outcomes after stroke may reflect the influence of social determinants of health on rehabilitation outcomes. Future work on this study will continue follow-up and examine the association of insurance status with other rehabilitation factors, like initiation of outpatient therapy.