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

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, ca...

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Autores principales: Smith, Jamie M., Jarrín, Olga F., Lin, Haiqun, Tsui, Jennifer, Dharamdasani, Tina, Thomas-Hawkins, Charlotte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003472/
https://www.ncbi.nlm.nih.gov/pubmed/33808769
http://dx.doi.org/10.3390/ijerph18063196
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author Smith, Jamie M.
Jarrín, Olga F.
Lin, Haiqun
Tsui, Jennifer
Dharamdasani, Tina
Thomas-Hawkins, Charlotte
author_facet Smith, Jamie M.
Jarrín, Olga F.
Lin, Haiqun
Tsui, Jennifer
Dharamdasani, Tina
Thomas-Hawkins, Charlotte
author_sort Smith, Jamie M.
collection PubMed
description 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.
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spelling pubmed-80034722021-03-28 Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes Smith, Jamie M. Jarrín, Olga F. Lin, Haiqun Tsui, Jennifer Dharamdasani, Tina Thomas-Hawkins, Charlotte Int J Environ Res Public Health Article 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. MDPI 2021-03-19 /pmc/articles/PMC8003472/ /pubmed/33808769 http://dx.doi.org/10.3390/ijerph18063196 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Smith, Jamie M.
Jarrín, Olga F.
Lin, Haiqun
Tsui, Jennifer
Dharamdasani, Tina
Thomas-Hawkins, Charlotte
Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
title Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
title_full Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
title_fullStr Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
title_full_unstemmed Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
title_short Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
title_sort racial disparities in post-acute home health care referral and utilization among older adults with diabetes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003472/
https://www.ncbi.nlm.nih.gov/pubmed/33808769
http://dx.doi.org/10.3390/ijerph18063196
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