Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.