{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T04:06:02Z","timestamp":1792555562985,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,10,26]]},"abstract":"\n Background<\/jats:title>\n Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government\u2010sponsored insurance had worse quality of care or in\u2010hospital outcomes in acute ischemic stroke.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65\u00a0years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in\u2010hospital mortality and postdischarge destination. We included 589\u00a0320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines\u2010Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the\n ED<\/jats:styled-content>\n , or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65\u00a0years,\n OR<\/jats:styled-content>\n 1.33 [95%\n CI<\/jats:styled-content>\n 1.22\u20101.45]; \u226565\u00a0years\n OR<\/jats:styled-content>\n 1.54 [95%\n CI<\/jats:styled-content>\n 1.34\u20101.75]), and among survivors, were less likely to go to inpatient rehab (<65\n OR<\/jats:styled-content>\n 0.63 [95%\n CI<\/jats:styled-content>\n 0.6\u20100.67]; \u226565\n OR<\/jats:styled-content>\n 0.56 [95%\n CI<\/jats:styled-content>\n 0.5\u20100.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65\u00a0years\n OR<\/jats:styled-content>\n 2.08 [\n CI<\/jats:styled-content>\n 1.96\u20102.2];\n OR<\/jats:styled-content>\n 2.01 [95%\n CI<\/jats:styled-content>\n 1.91\u20102.13]; \u226565\u00a0years\n OR<\/jats:styled-content>\n 1.1 [95%\n CI<\/jats:styled-content>\n 1.07\u20101.13];\n OR<\/jats:styled-content>\n 1.41 [95%\n CI<\/jats:styled-content>\n 1.35\u20101.46]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Preventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and in\u2010hospital mortality differ by patient insurance status.<\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.004282","type":"journal-article","created":{"date-parts":[[2016,11,15]],"date-time":"2016-11-15T02:25:27Z","timestamp":1479176727000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":78,"title":["Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines\u2010Stroke"],"prefix":"10.1161","volume":"5","author":[{"given":"Laura N.","family":"Medford\u2010Davis","sequence":"first","affiliation":[{"name":"Section\u00a0of Emergency Medicine, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson\u2010UCLA Cardiomyopathy Center, Ronald Reagan\u2010UCLA Medical Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haolin","family":"Xu","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Suter","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"},{"name":"Department of Cardiology, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xian","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"},{"name":"Department of Neurology, Duke University Medical Center, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland A.","family":"Matsouaka","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"},{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee H.","family":"Schwamm","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000366"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/hs0102.101014"},{"key":"e_1_3_5_4_2","unstructured":"Henry J Kaiser Family Foundation . 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