Abstract TP015: Association of Insurance Payor with Time to Discharge to Rehabilitation After Ischemic Stroke: A Retrospective Cohort Study

Introduction: Timely transition to post-acute rehabilitation after ischemic stroke is associated with higher functional recovery rates and lower downstream utilization. Discharge timing is a multidimensional process that can be influenced by nonclinical factors, including insurance payor. These factors may introduce non-medical disparities in access to adequate care. Previous works have largely been focused on discharge disposition, and ICU cohorts remain under-studied. We evaluated the association between insurance payor and time to ICU discharge, adjusting for direct admits to rehabilitation and stroke severity among adults with ischemic stroke in a large, critical-care database. Methods: We conducted a retrospective cohort study using the MIMIC-IV v3.1 database to evaluate the relationship between insurance status and time to discharge to rehabilitation among ischemic stroke patients. Adult admissions with a qualifying stroke diagnosis, from 2008 to 2019, were identified and linked with demographic, administrative, and ICU data. LOS was calculated as the difference between admission and discharge times, and discharge to rehabilitation was coded as a binary variable. Multivariable linear regression was used to model LOS by insurance status, adjusting for age, sex, race/ethnicity, rehab discharge disposition, and medical complexity measured by the Elixhauser comorbidity score. Results: A total of 4,954 ischemic stroke ICU patients were included in the analysis. Increasing Elixhauser was significantly associated with shorter hospital length of stay compared to discharge to other locations (coeff= -0.78; 95%CI: -1.3 - -0.22). Among insurance payors, private insurance was associated with the shortest LOS: 4.6 fewer days to discharge (95%CI: -6.5 - -2.8) compared to Medicaid, which was the longest. Medicare patients also demonstrated a significantly shorter time to discharge compared with Medicaid recipients. Conclusion: Privately insured ischemic stroke patients showed an association with quicker discharge to rehabilitation after controlling for age, race/ethnicity, gender, and medical complexity. These data suggest possible disparities in care amongst insurance payors that may delay advances to the next stage of management for ischemic stroke patients. Further investigation is needed to investigate the ongoing drivers of this relationship and examine the longitudinal consequences of such disparate delays to stroke rehabilitation.