Abstract P234: Stroke in Texas: Leveraging Population Level Data to Inform Public Health

Abstract

Introduction: We studied variation in stroke rates, post-discharge health services, and outcomes across payors in Texas. Methods: Claims for 48,331 stroke patients in 2016 and hospital data covering 58,114 discharges were analyzed. Prevalence and incidence rates per region were reported as a variation from the state mean by payor type (Medicaid, Medicare and Commercial). Stroke overall, ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage are reported. Stroke outcomes are reported for the following measures: Discharges to rehabilitation, 30-Day Follow-Up with neurologist, death within 45 days Results: Among all payors, east Texas had the highest incidence and prevalence of ischemic stroke (Fig) but Northern Texas had the highest incidence of ICH among Medicaid and Commercial payors. Medicaid patients showed the greatest increases across ages and displayed a higher prevalence rate among those aged 40-64 than the 65+ group. Medicaid had a higher rate for each age group when compared to commercial. Within Medicaid and commercial, the 0-17 age had a very high rate of death from ischemic stroke (121/1000 and 83/1000, respectively), greater than any of the other age bands except over age 65; these high rates were not observed in ICH. Commercial and Medicaid patients had low rates of discharge to rehabilitation compared with Medicare (354/1000, 130/1000, 424/1000, respectively). Outpatient follow-up rates with a neurologist were low: Medicaid rates were very low compared to Commercial and Medicare (22/1000, 387/1000, 267/1000, respectively). Conclusion: Statewide review revealed dramatic variation in regional rates across all payors and ages. Graphic display and public reporting of statewide data on stroke through population level transparency can be leveraged to identify areas of risk, intervention strategies, and inform public health policy.