355 Medicaid Status Is Independently Associated With 6-Month Loss to Follow-Up After Mechanical Thrombectomy: A 2022-2024 Single Institution Study in Greater Philadelphia

Le résumé fourni par la source

INTRODUCTION: Loss to follow-up (LTF) is associated with less representation in clinical research due to exclusion from outcomes analysis. Understanding the factors driving LTF is critical to ensuring equitable assessment of thrombectomy across diverse patient populations. METHODS: 457 consecutive thrombectomies for distinct patients were performed at the Hospital of the University of Pennsylvania between January 2022 to July 2024. Loss to follow-up was defined as absence of a phone call, clinic visit, or radiographic assessment after 6 months post-procedure. Median household income and percent non-citizen population were acquired from 5-year averages of the 2019-2023 US Census and correlated with patient zip codes, classified into quartiles. Race, Hispanic ethnicity, Medicaid status, age over 65, and favorable 90-day mRS outcome (mRS 0-2) were directly acquired through chart review. Multivariate logistic regression was then performed in RStudio (Posit Software, PBC). RESULTS: First quartile median household income (below $47,964) and fourth quartile non-citizen population (above 54.20%) by zip code were selected as variables. Neither race/ethnicity, median income, favorable mRS at 90 days, age over 65, or proportion of non-citizens had significant predictive value (p > 0.05). However, Medicaid status was associated with an increased risk of LTF at 6 months, with an odds ratio (OR) of 6.25 (95% CI: 1.56 – 30.0, p = 0.0132). CONCLUSIONS: Patients with Medicaid insurance had approximately sixfold higher odds of being lost to follow-up at 6 months compared to non-Medicaid patients, even after adjusting for age, race/ethnicity, clinical outcome, and zip code. Several structural factors may underlie this association. Administrative barriers—such as the requirement for a separate application for long-term care coverage under Medicaid in Pennsylvania—and lower shares of physicians who accept Medicaid patients likely complicate continuity of care.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.