Abstract WP48: Prescription Rate for Antihyperglycemic Medication With Proven Cardiovascular Benefit at Discharge in Stroke Patients Not Equal Among Payer Sources

Abstract

Background: Mortality doubles in stroke patients when Diabetes Mellitus (DM) is present. Target: Type 2 Diabetes SM (TT2DM) is an American Heart Association® (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Participating Get With The Guidelines® (GWTG)-Stroke hospitals track EBG data to improve outcomes. TT2DM initiative has10 EBG data elements related to stroke and the DM subpopulation. The measure  Antihyperglycemic Medication with Proven Cardiovascular (CVD) Benefit at Discharge in Stroke Patients with DM (AMPB) has low compliance. Further data analysis was needed. Methods: GWTG®-Stroke DM reports specific to AMPB were reviewed from Jan.1, 2020-Dec. 21, 2022, from 51 Wisconsin Coverdell Stroke hospitals. Analysis comprised of 5,045 patients with a primary diagnosis of stroke and history of DM or newly identified DM in the denominator. The numerator was satisfied when patients were prescribed a GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source. Payer sources were identified as: self-pay, Medicaid, Medicare, and Private/HMO. Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source. Only 2.3% identified as self-pay were prescribed AMPB at discharge. Differences in compliance rates were 10% for Medicare, 13.5% Medicaid, and 15.3% with private insurance/HMO. Conclusions: Discharge prescription rate for AMPB has low compliance, further variation exists among patient payer sources. Items for consideration are higher cost of medication and thus payer status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, along with existing medication knowledge gaps. Providing EBC requires shared decision making to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow-up needs may enhance compliance. Future considerations are to assess race “within” payer source to gauge if there is disparate care.