Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

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

Version 1 : Received: 29 January 2021 / Approved: 1 February 2021 / Online: 1 February 2021 (14:03:38 CET)

A peer-reviewed article of this Preprint also exists.

Smith, J.M.; Jarrín, O.F.; Lin, H.; Tsui, J.; Dharamdasani, T.; Thomas-Hawkins, C. Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes. Int. J. Environ. Res. Public Health 2021, 18, 3196. Smith, J.M.; Jarrín, O.F.; Lin, H.; Tsui, J.; Dharamdasani, T.; Thomas-Hawkins, C. Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes. Int. J. Environ. Res. Public Health 2021, 18, 3196.

Journal reference: Int. J. Environ. Res. Public Health 2021, 18, 3196
DOI: 10.3390/ijerph18063196

Abstract

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and out-comes including disabling and life-threatening complications. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordina-tion, and psychosocial support for patients and their caregivers. This study examined factors as-sociated with hospital discharge to home health care and subsequent utilization of home health care among a cohort of Medicare beneficiaries with diabetes, age 50 and older, living in the United States. The cohort (n=786,758) was followed for 14 days after a 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 area deprivation, and rural/urban setting. In ful-ly 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) compared to white patients. Among those discharged to home health care, all racial/ethnic minority patients were less likely to receive services within 14-days. Further work should focus on eliminating systemic racism in home health care referral and systemic barriers to receiving home health care services.

Keywords

Chronic conditions; diabetes; older adults; race or ethnicity; health care access; home health care; social determinants of health; inequalities or inequities

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