Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients

Erica C. Leifheit, Yun Wang, George Howard, Virginia J. Howard, Larry B. Goldstein, Thomas G Brott, Judith H. Lichtman

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

METHODS: The study cohort included fee-for-service Medicare beneficiaries ≥65 years of age who underwent CEA (ICD-9-CM code 38.12) between 2003 and 2010. Beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We fit mixed models to assess the relationship between coverage (dual eligible vs Medicare only) and outcomes over time after adjustment for demographic and clinical characteristics.

RESULTS: There were 53,773 dual-eligible and 452,182 Medicare-only beneficiaries hospitalized for CEA. The percentage of dual-eligible patients receiving CEA increased from 10.1% in 2003 to 11.5% in 2010, with no change in geographic distribution across the country. In adjusted analyses, dual-eligible vs Medicare-only beneficiaries had a higher rate of 30-day ischemic stroke or death; higher in-hospital, 30-day, and 1-year all-cause mortality; and higher 30-day all-cause readmission. Relative annual reductions in outcomes from 2003 to 2010 ranged from 2% to 5%, but there was no significant interaction between dual-eligible status and time.

OBJECTIVE: To determine whether patients who are dual eligible for Medicare and Medicaid benefits have outcomes after carotid endarterectomy (CEA) that are comparable to the outcomes of those eligible for Medicare alone.

CONCLUSIONS: Dual-eligible beneficiaries had worse outcomes than those eligible for Medicare alone. Additional work is necessary to understand the reasons for this difference.

Original languageEnglish (US)
Pages (from-to)e1553-e1558
JournalNeurology
Volume91
Issue number17
DOIs
StatePublished - Oct 23 2018

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Carotid Endarterectomy
Medicaid
Medicare
Fee-for-Service Plans
International Classification of Diseases
Cohort Studies
Stroke
Demography
Mortality

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Leifheit, E. C., Wang, Y., Howard, G., Howard, V. J., Goldstein, L. B., Brott, T. G., & Lichtman, J. H. (2018). Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients. Neurology, 91(17), e1553-e1558. https://doi.org/10.1212/WNL.0000000000006380

Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients. / Leifheit, Erica C.; Wang, Yun; Howard, George; Howard, Virginia J.; Goldstein, Larry B.; Brott, Thomas G; Lichtman, Judith H.

In: Neurology, Vol. 91, No. 17, 23.10.2018, p. e1553-e1558.

Research output: Contribution to journalArticle

Leifheit, EC, Wang, Y, Howard, G, Howard, VJ, Goldstein, LB, Brott, TG & Lichtman, JH 2018, 'Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients', Neurology, vol. 91, no. 17, pp. e1553-e1558. https://doi.org/10.1212/WNL.0000000000006380
Leifheit, Erica C. ; Wang, Yun ; Howard, George ; Howard, Virginia J. ; Goldstein, Larry B. ; Brott, Thomas G ; Lichtman, Judith H. / Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients. In: Neurology. 2018 ; Vol. 91, No. 17. pp. e1553-e1558.
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N2 - METHODS: The study cohort included fee-for-service Medicare beneficiaries ≥65 years of age who underwent CEA (ICD-9-CM code 38.12) between 2003 and 2010. Beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We fit mixed models to assess the relationship between coverage (dual eligible vs Medicare only) and outcomes over time after adjustment for demographic and clinical characteristics.RESULTS: There were 53,773 dual-eligible and 452,182 Medicare-only beneficiaries hospitalized for CEA. The percentage of dual-eligible patients receiving CEA increased from 10.1% in 2003 to 11.5% in 2010, with no change in geographic distribution across the country. In adjusted analyses, dual-eligible vs Medicare-only beneficiaries had a higher rate of 30-day ischemic stroke or death; higher in-hospital, 30-day, and 1-year all-cause mortality; and higher 30-day all-cause readmission. Relative annual reductions in outcomes from 2003 to 2010 ranged from 2% to 5%, but there was no significant interaction between dual-eligible status and time.OBJECTIVE: To determine whether patients who are dual eligible for Medicare and Medicaid benefits have outcomes after carotid endarterectomy (CEA) that are comparable to the outcomes of those eligible for Medicare alone.CONCLUSIONS: Dual-eligible beneficiaries had worse outcomes than those eligible for Medicare alone. Additional work is necessary to understand the reasons for this difference.

AB - METHODS: The study cohort included fee-for-service Medicare beneficiaries ≥65 years of age who underwent CEA (ICD-9-CM code 38.12) between 2003 and 2010. Beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We fit mixed models to assess the relationship between coverage (dual eligible vs Medicare only) and outcomes over time after adjustment for demographic and clinical characteristics.RESULTS: There were 53,773 dual-eligible and 452,182 Medicare-only beneficiaries hospitalized for CEA. The percentage of dual-eligible patients receiving CEA increased from 10.1% in 2003 to 11.5% in 2010, with no change in geographic distribution across the country. In adjusted analyses, dual-eligible vs Medicare-only beneficiaries had a higher rate of 30-day ischemic stroke or death; higher in-hospital, 30-day, and 1-year all-cause mortality; and higher 30-day all-cause readmission. Relative annual reductions in outcomes from 2003 to 2010 ranged from 2% to 5%, but there was no significant interaction between dual-eligible status and time.OBJECTIVE: To determine whether patients who are dual eligible for Medicare and Medicaid benefits have outcomes after carotid endarterectomy (CEA) that are comparable to the outcomes of those eligible for Medicare alone.CONCLUSIONS: Dual-eligible beneficiaries had worse outcomes than those eligible for Medicare alone. Additional work is necessary to understand the reasons for this difference.

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