Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults

Li, Jun; Qi, Mingyu; Werner, Rachel M.

doi:10.1001/jamanetworkopen.2020.15470

Cited by 28 publications

(44 citation statements)

References 9 publications

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“…To our knowledge, no other studies have examined home health care utilization among American Indian/Alaska Native (AIAN) patients; however, disparities in health services utilization have been reported including forgoing medical care [ 37 ], lack of primary providers [ 38 ], and high rates of hospital readmissions [ 39 ], generally attributed to geographic and socioeconomic barriers [ 40 ]. Our findings for AAPI and Hispanic patients are consistent with prior studies of Medicare beneficiaries with Hawaiian [ 41 ] or national samples [ 33 , 42 ]. Barriers to timely referral and utilization of post-acute home health care may be a contributing factor to the increased risk of severe diabetes-related complications observed in racial and ethnic minorities [ 43 ].…”

Section: Discussionsupporting

confidence: 91%

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

Smith

Jarrín

Lin

et al. 2021

IJERPH

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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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Section: Discussionsupporting

confidence: 91%

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

Smith

Jarrín

Lin

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…To our knowledge, no other studies have examined home care utilization among American Indian/Alaska Native (AIAN) patients, however disparities in health services utilization have been reported including forgoing medical care [32], lack of primary providers [33], and higher rates of hospital readmissions [34], generally attributed to geographic and socioeconomic barriers [35]. Our findings for AAPI and Hispanic patients are, consistent with prior studies of Medicare beneficiaries with Hawaiian [36], or national samples [28,37]. Barriers to timely referral and utilization of post-acute home health care may be a contributing factor to the increased risk of severe diabetes-related complications observed in racial and ethnic minorities [38].…”

Section: Discussionsupporting

confidence: 86%

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

Smith¹,

Jarrín²,

Lin³

et al. 2021

Preprint

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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.

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“…Institutional and structural barriers can cause delayed or missed care. In recent studies of Medicare patients discharged to home health care in 2015–2016, 54% of all hospitalizations [ 17 ] and 73% of patients with a diabetes-related stay [ 18 ] received home health care within two weeks of discharge. Racial/ethnic disparities in post-acute referral and utilization of home health care were observed in both studies for non-Hispanic Black, Asian American/Pacific Islander (AAPI), American Indian/Alaska Native (AIAN), and Hispanic patients compared to (non-Hispanic) WHITE patients [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In recent studies of Medicare patients discharged to home health care in 2015–2016, 54% of all hospitalizations [ 17 ] and 73% of patients with a diabetes-related stay [ 18 ] received home health care within two weeks of discharge. Racial/ethnic disparities in post-acute referral and utilization of home health care were observed in both studies for non-Hispanic Black, Asian American/Pacific Islander (AAPI), American Indian/Alaska Native (AIAN), and Hispanic patients compared to (non-Hispanic) WHITE patients [ 17 , 18 ]. Efforts are ongoing to standardize institutional processes using clinical decision tools for referral decisions during the discharge planning and to prioritize home health visits at the agency level [ 12 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

Smith

Lin

Thomas‐Hawkins

et al. 2021

IJERPH

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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 admission during 2015. 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 and geographic variables, and neighborhood socioeconomic 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 the patients who received home health care within the recommended first two days, the 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 the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two 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.

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Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults

Cited by 28 publications

References 9 publications

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

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

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

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

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