Abstract 273: Prescription Rate For Antihyperglycemic Medication With Proven Cvd Benefit At Discharge In Stroke Patients Not Equal Among Payer Sources

Mortality doubles in stroke patient with diabetes mellitus (DM). Target: Type 2 DiabetesSM (TT2DM) is an American Heart Association (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Get With The Guidelines® (GWTG)- Stroke hospitals track EBG data to improve patient outcomes. TT2DM initiative is comprised of 10 EBG data elements related to stroke and DM subpopulation. The measure Antihyperglycemic Medication with Proven CVD Benefit at Discharge in Stroke Patients with DM has low compliance.

Methods: GWTG®-Stroke DM reports reviewed from January 1, 2020-June 30, 2021, from 50 Wisconsin Coverdell Stroke Program hospitals. Analysis of 2554 patients with primary diagnosis of stroke with history of or newly identified DM during hospitalization were in the denominator. Numerator met when patients were prescribed GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source documented. Patient payer source was identified as: Self-Pay, Medicaid, Medicare, and Private. Findings: In specified timeframe, 7.9% of patients received Antihyperglycemic Medication with Proven CVD Benefit at Discharge. Compliance variation exists across payer source. Differences in compliance rates were 2.2% Self-Pay, 6.4% for Medicare, 7.7% Medicaid, and 12.1% for Private.

Conclusions: Discharge prescription rate for antihyperglycemic medication with proven CVD benefit at discharge in stroke patients has low compliance, further variation exists among payor sources. Items for consideration are higher cost of medication and thus payor status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, there may be a medication knowledge gap. Providing EBC requires shared decision making among patients and clinicians to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow up needs may enhance compliance. Future considerations are to assess race “within” payor source to gauge if there is disparate care.