Centers for medicare and medicaid services medicare data and stroke research: goldmine or landmine?

Abstract

Stroke, a major public health problem in the United States, is the country’s fourth leading cause of death and a leading cause of serious disability. There are an estimated 6.8 million stroke survivors in the United States, with ≈795 000 people having a new or recurrent stroke annually.1 Its high prevalence and the functional deficits resulting from stroke impose a large burden on patients, their families, the healthcare system, and society. This is especially true among the elderly, for whom cerebrovascular diseases (stroke and transient ischemic attacks) are the second leading cause of hospitalization.2,3 Of those hospitalized with stroke, two thirds are aged ≥65 years; half are ≥70 years. With the aging of the population, the absolute number of elderly people with stroke is expected to increase in the coming decades.4 The availability of national Medicare data relevant to the care and outcomes of older patients with stroke in the United States represents a valuable, yet largely untapped, resource. Medicare is the largest health insurance program in the United States, providing coverage for hospital, skilled nursing facility, home health, and hospice care, as well as outpatient services and prescription drugs, to millions nationwide. Approximately 52.3 million (≈1 in 6) Americans were enrolled in Medicare during 2013, including 43.5 million of those aged ≥65 years; by 2030, the program is expected to serve >81 million people.5 Stroke is one of the 10 highest contributors to Medicare costs.6 The estimated direct medical cost of stroke in the United States in 2012 was $71.6 billion, with an additional $33.7 billion in indirect costs attributable to loss of productivity (2010 dollars); these estimates are projected to triple by 2030.4 There is a growing need for evidence-based knowledge about organizational strategies, structural characteristics, and healthcare policies that …