Abstract MP26: Medicaid Expansion Did Not Reduce Stroke Readmissions After One Year

• Published in: Stroke (1970) 2021-03, Vol.52 (Suppl_1), p.AMP26-AMP26
• Main Authors: McGee, Blake T, Kim, Seiyoun
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.52.suppl_1.MP26

IntroductionUp to 21% of stroke survivors are re-hospitalized within 30 days. Health insurance promotes access to follow-up care that can mitigate the risk of readmission, but 12 states do not participate in the Affordable Care Act’s Medicaid expansion. HypothesisThe probability of 30-day hospital readmission after acute ischemic stroke was lower in Medicaid expansion states than in non-expansion states. MethodsA retrospective, quasi-experimental study using six inpatient databases from AHRQ’s Healthcare Cost and Utilization Projectfour from expansion states (AR, MD, NM and WA) and two non-expansion (FL and GA). The sample comprised all patients hospitalized in 2012-14 with a principal diagnosis of ischemic stroke (ICD-9-CM 433.x1, 434.x1 or 436) who were aged 19-64; resided in the state where admitted; had a primary payer of Medicaid, self-pay or no charge; and were discharged alive (N=18,766). Mixed effects logit models with a time-by-treatment interaction were built to test if the probability of readmission changed differentially between expansion and non-expansion states from 2012-13 (before expansion) to 2014. Any in-state hospitalization within 30 days of discharge (except for rehabilitation, psychiatry, or cancer treatment) was considered a readmission. A secondary analysis of unplanned, potentially preventable readmissions (adapted from the AHRQ Prevention Quality Indicators) was also conducted. Models included race, sex, age, number of diagnoses, median household income quartile of patient ZIP code, and metropolitan residence as fixed effects, with random intercepts for hospital and state. ResultsIn 2012-13, 8.9% of the expansion state patients were readmitted compared to 9.0% in non-expansion states; in 2014, 11.1% were readmitted in expansion states versus 10.5% in non-expansion states. In multivariable models, the time-by-treatment interaction was not statistically significantβ=0.072, p=.541, for all readmissions, β=0.168, p=.683, for unplanned, potentially preventable readmissions. ConclusionsMedicaid expansion did not reduce 30-day readmissions after stroke in the first year of implementation in four diverse states. Stroke readmissions among non-elderly adults require more targeted interventions.