Working Paper Article Version 2 This version is not peer-reviewed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)
Version 2 : Received: 5 April 2021 / Approved: 6 April 2021 / Online: 6 April 2021 (14:40:37 CEST)

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

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. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical, geographic variables, and neighborhood socio-economic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to patients who received home health care within the recommended first two days, patients who received delayed services (3-7 days after discharge) had higher odds of rehospitalization (OR 1.28, 95% CI 1.25-1.32). Among patients who received late services (8-14 days after discharge), the odds of rehospitalization were four times greater than for patients receiving services within 2 days (OR 4.12, 95% CI 3.97-4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

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: 6 April 2021
Commenter: Olga Jarrín
Commenter's Conflict of Interests: Author
Comment: Revised manuscript
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