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Stroke, Medicare, healthcare utilization, epidemiology, population-based, caregiving

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Background—Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs.

Aim—To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a United States (US) population-based sample.

Methods—Claims were examined over a 6-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 vs. White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver.

Results—After adjusting for covariates, women were more likely than men to receive home health care and to use emergency department services during the post-acute care period. These effects were maintained even after further adjustment for acute stroke severity. African Americans had more home health care visits than Whites among patients who received some home health care. Having a co-residing caregiver was associated with reduced acute hospitalization length of stay and fewer post-acute emergency department and primary care physician visits.

Conclusions—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.

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International Journal of Stroke, v. 11, issue 8, p. 928-934

D.L. Roth, O.C. Sheehan, J. Huang, J.D. Rhodes, S.E. Judd, M. Kilgore, B. Kissela, J. P. Bettger, & W.E. Haley, Medicare Claims Indicators of Healthcare Utilzation Differences after Hospitilization for Ischemic Stroke: Race, Gender, and Caregiving Effects, 11(8), 928-934. © The Authors 2015. Reprinted by permission of SAGE Publications.

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