Effect of insurance status on initial interction with the medical care system in acute stroke: regional data from the Coverdell project

Background: Appropriate early diagnosis and care improves outcome in stroke. Insurance status may affect early mangement. Methods: Illinois CAPTURE-Stroke collected data from consecutive acute stroke cases at 13 hospitals over 5 months. Demographic and clinical data were abstracted from charts and entered into a secure web-based system. 726 cases were analyzed. Patients were categorized as uninsured (UN n=82), Medicaid only (MA n=29), or insured (INS incl BC/BS, Medicare, PPO/HMO n=613). Results: Demographics: INS were less often nonwhite (29%) and older (mean age 72) than MA (83 NW, mean age 61) and UN (62% NW, mean age 52). INS and MA had higher rates of medical comorbidities than UN patients. Presentation: Time to see a doctor was shorter for INS (mean 23 min INS v 55 min MA, 48 min UN). Time to first CT did not differ substantially across groups. Acute stroke teams consulted on 26% of UN, 52% of MA, and 57% of INS. Hospital course: Length of stay did not differ substantially among groups. Complication rates (DVT, UTI, pneumonia) were higher in INS. Disposition: All groups received antithrombotics in ischemic stroke. UN received aspirin rather than other agents. INS were more often discharged to nursing homes. Conclusion: UN and MA fared at least as well as INS despite differences in care. Age and comorbidites may contribute; regional differences in hospital resources need further study.