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Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Author

Listed:
  • Jamie M. Smith

    (College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA
    School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA)

  • Olga F. Jarrín

    (School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA
    Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA)

  • Haiqun Lin

    (School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA
    School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA)

  • Jennifer Tsui

    (Keck School of Medicine of USC, University of Southern California, Los Angeles, LA 90033, USA)

  • Tina Dharamdasani

    (School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA)

  • Charlotte Thomas-Hawkins

    (School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA)

Abstract

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort ( n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.

Suggested Citation

  • Jamie M. Smith & Olga F. Jarrín & Haiqun Lin & Jennifer Tsui & Tina Dharamdasani & Charlotte Thomas-Hawkins, 2021. "Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes," IJERPH, MDPI, vol. 18(6), pages 1-14, March.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:6:p:3196-:d:520543
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    References listed on IDEAS

    as
    1. Darrell J. Gaskin & Eric T. Roberts & Kitty S. Chan & Rachael McCleary & Christine Buttorff & Benjo A. Delarmente, 2019. "No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality," IJERPH, MDPI, vol. 16(7), pages 1-18, April.
    2. Jiang, H.J. & Andrews, R. & Stryer, D. & Friedman, B., 2005. "Racial/ethnic disparities in potentially preventable readmissions: The case of diabetes," American Journal of Public Health, American Public Health Association, vol. 95(9), pages 1561-1567.
    3. Caroline King & Sidney Atwood & Mia Lozada & Adrianne Katrina Nelson & Chris Brown & Samantha Sabo & Cameron Curley & Olivia Muskett & Endel John Orav & Sonya Shin, 2018. "Identifying risk factors for 30-day readmission events among American Indian patients with diabetes in the Four Corners region of the southwest from 2009 to 2016," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-10, August.
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