What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic stroke (n=254902). Intervention: Dual Medicare-Medicaid eligibility vs. Medicare only. Primary outcome: 1-year all-cause mortality (OR 1.20, 95% CI 1.17-1.23, p=<0.001).

October 5, 2023PLoS ONEOpen Access

Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States

Q: What are the key findings of this study?

Dual Medicare-Medicaid-eligible patients hospitalized for ischemic stroke had significantly greater odds of 1-year mortality (OR 1.20) and 1-year readmission (HR 1.03) compared to Medicare-only patients.

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Key result

Dual Medicare-Medicaid eligibility linked to ~20% greater 1-year mortality after ischemic stroke versus Medicare alone.

OR 1.20
95% CI 1.17-1.23
P<0.001
n=254,902

Why the study?

Little is known about whether low-income dual Medicare-Medicaid beneficiaries have worse outcomes after stroke than patients with Medicare alone.

Does dual Medicare-Medicaid eligibility increase the risk of mortality and readmission in older adults hospitalized for ischemic stroke compared to Medicare alone?

Population

254,902 fee-for-service Medicare beneficiaries aged ≥65 years hospitalized with ischemic stroke

Comparison

Dual Medicare-Medicaid eligibility vs Medicare alone

Design

Retrospective observational cohort study

Follow-up

Up to 1 year

Authors

ELErica C Leifheit YWYun Wang LGLarry B. Goldstein

Discussion

Member takes

Overview

Dual eligibility was associated with higher post-stroke risks; leaves open whether targeted interventions improve outcomes in this population.

Study Design

Type

Observational (n=254,902)

Multicenter

Yes

Structured PICO

Does dual Medicare-Medicaid eligibility increase the risk of mortality and readmission in older adults hospitalized for ischemic stroke compared to Medicare alone?

Population

254,902 fee-for-service Medicare beneficiaries aged 65 years or older hospitalized with ischemic stroke, followed for up to 1 year to compare outcomes between dual Medicare-Medicaid eligible and Medicare-only patients.

Exposure

Dual Medicare-Medicaid eligibility (≥1 month of Medicaid coverage).

Comparator

Medicare-only coverage.

Outcome

In-hospital, 30-day, and 1-year all-cause mortality; and 30-day and 1-year all-cause readmission.hard clinical

Main Result

Odds Ratio: 1.2 (95% CI 1.17–1.23)

Absolute Event Rate: 28.6% vs 24.4%

p-value: p=<0.001

Dual-eligible Medicare-Medicaid beneficiaries hospitalized for ischemic stroke have significantly higher 1-year mortality and readmission rates compared to Medicare-only patients, highlighting a vulnerable population that may require enhanced post-acute care.

Limitations

Based on Medicare administrative claims data, which are subject to potential coding errors and variation in coding practices.
Claims data lack detailed clinical information such as neuroimaging, stroke severity, and functional status.
Limited to fee-for-service Medicare beneficiaries aged 65 years or older, so results may not generalize to younger patients or those with Medicare Advantage.
Medicaid eligibility, services, and funding vary by state, and the study was unable to characterize the specific support provided to patients.
Based on Medicare administrative claims data, which are subject to potential coding errors and variation
Lack of detailed clinical information (e.g., neuroimaging, stroke severity, functional status)
Limited to fee-for-service Medicare beneficiaries aged 65 years or older, so results may not generalize to younger patients or those without this coverage
Unable to characterize the specific Medicaid support provided to patients due to state-level variation

Cite This Study

Leifheit et al. (2023) conducted an observational in Ischemic stroke (n=254,902). Dual Medicare-Medicaid eligibility vs. Medicare only was evaluated on 1-year all-cause mortality (OR 1.20, 95% CI 1.17-1.23, p=<0.001). Dual Medicare-Medicaid-eligible patients hospitalized for ischemic stroke had significantly greater odds of 1-year mortality (OR 1.20) and 1-year readmission (HR 1.03) compared to Medicare-only patients.

synapsesocial.com/papers/6a202e76eaa49a33b5fc064d https://doi.org/10.1371/journal.pone.0292546

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October 5, 2023PLoS ONEOpen Access

Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States

View Full Paper

Ask AI

Bookmark

Key result

Dual Medicare-Medicaid eligibility linked to ~20% greater 1-year mortality after ischemic stroke versus Medicare alone.

OR 1.20
95% CI 1.17-1.23
P<0.001
n=254,902

Why the study?

Little is known about whether low-income dual Medicare-Medicaid beneficiaries have worse outcomes after stroke than patients with Medicare alone.

Does dual Medicare-Medicaid eligibility increase the risk of mortality and readmission in older adults hospitalized for ischemic stroke compared to Medicare alone?

Population

254,902 fee-for-service Medicare beneficiaries aged ≥65 years hospitalized with ischemic stroke

Comparison

Dual Medicare-Medicaid eligibility vs Medicare alone

Design

Retrospective observational cohort study

Follow-up

Up to 1 year

Authors

ELErica C Leifheit YWYun Wang LGLarry B. Goldstein

Discussion

Member takes

Overview

Dual eligibility was associated with higher post-stroke risks; leaves open whether targeted interventions improve outcomes in this population.

Study Design

Type

Observational (n=254,902)

Multicenter

Yes

Structured PICO

Does dual Medicare-Medicaid eligibility increase the risk of mortality and readmission in older adults hospitalized for ischemic stroke compared to Medicare alone?

Population

Exposure

Dual Medicare-Medicaid eligibility (≥1 month of Medicaid coverage).

Comparator

Medicare-only coverage.

Outcome

In-hospital, 30-day, and 1-year all-cause mortality; and 30-day and 1-year all-cause readmission.hard clinical

Main Result

Odds Ratio: 1.2 (95% CI 1.17–1.23)

Absolute Event Rate: 28.6% vs 24.4%

p-value: p=<0.001

Limitations

Based on Medicare administrative claims data, which are subject to potential coding errors and variation in coding practices.
Claims data lack detailed clinical information such as neuroimaging, stroke severity, and functional status.
Limited to fee-for-service Medicare beneficiaries aged 65 years or older, so results may not generalize to younger patients or those with Medicare Advantage.
Medicaid eligibility, services, and funding vary by state, and the study was unable to characterize the specific support provided to patients.
Based on Medicare administrative claims data, which are subject to potential coding errors and variation
Lack of detailed clinical information (e.g., neuroimaging, stroke severity, functional status)
Limited to fee-for-service Medicare beneficiaries aged 65 years or older, so results may not generalize to younger patients or those without this coverage
Unable to characterize the specific Medicaid support provided to patients due to state-level variation

Cite This Study

synapsesocial.com/papers/6a202e76eaa49a33b5fc064d https://doi.org/10.1371/journal.pone.0292546

Also Consider

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