Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

Version 1 : Received: 29 January 2021 / Approved: 1 February 2021 / Online: 1 February 2021 (11:49:12 CET)

How to cite: Smith, J.M.; Jarrín, O.F.; Lin, H.; Thomas-Hawkins, C.; Tsui, J. Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity. Preprints 2021, 2021020017 (doi: 10.20944/preprints202102.0017.v1). Smith, J.M.; Jarrín, O.F.; Lin, H.; Thomas-Hawkins, C.; Tsui, J. Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity. Preprints 2021, 2021020017 (doi: 10.20944/preprints202102.0017.v1).

Abstract

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. Building on prior findings of racial/ethnic disparities in post-acute referral and utilization of home health, this study examined timing of home health care initiation and 30-day rehospitalization outcomes. Using linked Medicare administrative, assessment, and claims datasets (2014-2016), we identified 209,150 Medicare beneficiaries, age 50 and older, who were referred to post-acute home health following a diabetes-related index hospitalization. Multivariate logistic regression models included patient demographics, neighborhood area deprivation, and rural/urban setting. Home health care initiated within one week was associated with lower risk of 30-day rehospitalization (days 0-2, OR=0.88, 95% CI 0.86-0.91; days 3-7, OR=0.87, CI 0.84-0.90). In contrast, a late start of services (days 8-14) was associated with a higher risk of 30-day rehospitalization (OR=2.2, CI 2.0-2.3). This pattern of results was observed across all racial/ethnic patient groups. However, racial/ethnic minority patients were less likely to receive timely home health care services compared to white patients. Timely initiation and coordination of home health care is one strategy to improve outcomes following diabetes-related hospitalizations that benefits older adults of all racial/ethnic groups.

Subject Areas

chronic conditions; diabetes; older adults; race or ethnicity; social determinants of health; in-equalities or inequities; policy; health care access; home health care

Comments (1)

Comment 1
Received: 2 March 2021
Commenter: Gary Brazzell
The commenter has declared there is no conflict of interests.
Comment: A very interesting and important article. It is interesting to note that the data set used by Smith et al had 57.5% of home health agencies starting care within two days of discharge. However, Medicare's Care Compare data set records 95.7% of home health agencies starting care within two days of a referral. This may suggest that a significant portion of home health referrals out of hospitals later prove non-responsive or resistant to the home health agency after the patient returns home. The hospitals may be counting referrals as made, but the home health agencies may be counting those same referrals as not received.
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Response 1 to Comment 1
Received: 3 March 2021
Commenter: Olga F. Jarrín Montaner, PhD, RN
The commenter has declared there is no conflict of interests.
Comment: Thank you for your interest in the topic and our paper. The statistic you mention (57.5%) is the proportion of patients (not agencies) in the sample who were discharged from a diabetes-related hospitalization to home health care that received a visit within 2 days of discharge. This is not directly comparable to Medicare Care Compare for a few reasons. As you note, Medicare Care Compare (formerly Home Health Compare) uses a different denominator, based on patients that had a start-of-care/resumption of care visit, including both post-acute and community referrals. There is also an exception to the standard of beginning care within two days of referral __or__ inpatient facility discharge, described in interpretive guidelines §484.55(a)(1) "...In instances where the patient requests a delay in the start of care date, the HHA would need to contact the physician to request a change in the start of care date and such change would need to be documented in the medical record."

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