Initial Encounter and Discharge Disposition of Medicare Beneficiaries with Post-Stroke Dysphagia

Molly Jacobs¹Richard Lindrooth²Marcelo Perraillon³Karen Wheeler-Hegland⁴Robert Mcgowan²Charles Ellis^4*

• ¹Department of Health Services Research, Management and Policy, University of Florida, Gainesville, United States
• ²University of Colorado Anschutz Medical Campus, Aurora, United States
• ³Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
• ⁴Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, United States

Introduction: Dysphagia or disordered swallowing is a post-stroke condition that requires early intervention to improve stroke recovery. Individuals with dysphagia require specialized services to support nutrition and reduce likelihood of pneumonia after stroke. This study was designed to utilize Medicare claims data to better understand the acute and post-acute pathways of stroke patients with dysphagia.Methods: Data included 100% of FFS Medicare claims for Home Health Agency (HHA), Skilled Nursing Facility (SNF), Inpatient, Outpatient, and Carrier files. The sample included Medicare beneficiaries who incurred an inpatient claim between January 1, 2016 and October 1, 2019 with ischemic or hemorrhagic stroke as the primary diagnosis.We identified 745,917 unique FFA Medicare beneficiaries with a primary stroke diagnosis; 90% were over age 65. Approximately 79% were non-Hispanic (NH) White, 12% were Black/African American, and 6% were Hispanic. Among those identified stroke survivors, 32.5% were diagnosed with dysphagia within 90 days with slight racial/ethnic variations. Between 68% and 73% of people with dysphagia (PWD) had their initial service encounter in an inpatient hospital facility, 15% to 16% in a skilled nursing facility, and 4% to 5% in an outpatient facility and there was little variation across race/ethnicity. Roughly 10% to12% of PWD were discharged directly home, 32% to 36% were discharged to a skilled nursing facility, and 33% to 36% were discharged to a longterm care, or rehabilitation facility.Discussion: In this study of Medicare data, the rate of dysphagia after stroke among Medicare beneficiaries was ~33%. This rate showed only slight variation across racial and ethnic groups. Roughly 70% of PWD were identified in inpatient settings. Only a small percentage (10%) were discharged home with roughly 80% moving to facilities offering rehabilitative services (skilled nursing, long-term care, or rehabilitation facility).