Related Experiment Video
Updated: Jun 21, 2026

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke
James E Graham1, Cynthia M Ripsin, Anne Deutsch
1Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555-1137, USA. jegraham@utmb.edu
Objectives:
To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.
Design:
Secondary data analysis.
Setting:
Inpatient rehabilitation facilities (N=864) across the United States.
Participants:
Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.
Intervention:
None.
Main Outcome Measures:
Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.
Results:
Mean +/- standard deviation age of the sample was 70.4+/-13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.
Conclusions:
The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age.
Related Concept Videos
Complications of Diabetes Mellitus
Diabetic Retinopathy
Type II Diabetes II: Pathophysiology
Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Diabetes Mellitus: Type 2 and Gestational
Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...