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. 2021 Mar 19;18(6):3196.
doi: 10.3390/ijerph18063196.

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

Jamie M Smith  1   2 , Olga F Jarrín  2   3 , Haiqun Lin  2   4 , Jennifer Tsui  5 , Tina Dharamdasani  4 , Charlotte Thomas-Hawkins  2
Affiliations

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

Jamie M Smith et al. Int J Environ Res Public Health. .

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.

Keywords: chronic conditions; diabetes; health care access; home health care; inequalities or inequities; older adults; race or ethnicity; social determinants of health.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Delimitation of index hospitalizations and study sample.
Figure 2
Figure 2
Discharge destination and 14-day home health care (HHC) utilization outcomes for sample (n = 786,758). Note: Solid lines represent expected patterns; dashed lines represent unexpected patterns. (a) 56,152 (27%) patients who were discharged to HHC did not receive services. (b) 61,565 (11%) patients who were discharged home without HHC received services.
See this image and copyright information in PMC

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