Racial and Ethnic Group Variations in Service Use in a National Sample of Medicare Home Health Care Patients with Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus is known to affect adults in racial and ethnic minority groups disproportionately. When diabetes mellitus–related symptoms lead to the need for skilled care in the community-dwelling Medicare population, physicians can order the Medicare home health care (HHC) benefit, and Medicare-certified home health agencies can deliver it. Little is known about the extent to which racial and ethnic disparities exist in types and patterns of HHC services delivered to Medicare beneficiaries with diabetes mellitus when they are approved for the Medicare HHC benefit. This was examined by comparing racial and ethnic groups in terms of measures of HHC service use in a nationally representative sample of Medicare HHC beneficiaries with a primary diagnosis of type 2 diabetes mellitus. Uniform clinical data from the Outcome and Assessment Information Set were linked with Medicare HHC claims for beneficiaries who received a complete episode of HHC in 2002. In the study sample (n = 9,838), 62% of participants self-identified as white, 22% African American, 12% Hispanic, and 3% Asian. Nearly all (99%) participants in all racial and ethnic groups received skilled nursing services. Controlling for numerous sociodemographic and health-related covariates and geographic region of the country, African-American participants received fewer nurse visits per week and fewer visits per week from all clinical disciplines combined than whites (both P<.001), and Hispanic participants were less likely than whites to receive physical therapy (adjusted odds ratio (AOR) = 0.640, 95% confidence interval (CI) = 0.543–0.754, P<.001) or home health aide (AOR = 0.716, 95% CI = 0.582–0.880, P<.002) services. Lower use of skilled nursing and rehabilitation services by African Americans and of rehabilitation services by Hispanics warrant further clinical and research attention.

Racial/Ethnic Variability in Diabetes Mellitus among United States Residents Is Unexplained by Lifestyle, Sociodemographics and Prognostic Factors

“…In general, it is logical to expect higher education to be associated with lower prevalence of diabetes mellitus because individuals who are educated are more likely to understand the risk factors for diabetes mellitus and apply this knowledge in controlling behavior towards risk factors reduction, namely, alcohol, smoking, and physical inactivity. Lower education level has been associated with increased risk of diabetes mellitus and other chronic diseases [29][30][31][32], and our results clearly support these previous data [33][34][35][36][37][38][39][40].…”

Risk Factors for Hospitalization in a National Sample of Medicare Home Health Care Patients

“…In the context of Medicare HHC, because hospitalization is considered an indicator of potentially poorer quality of care, one explanation for this finding is that Blacks may receive inferior quality of HHC. A recent national study of HHC patients with a primary diagnosis of type 2 diabetes mellitus found that Blacks received less skilled care from nurses and from rehabilitation therapists during their HHC episodes than did their White counterparts (Yeboah-Korang, Kleppinger, & Fortinsky, 2011). An equally plausible alternative explanation is that Black Medicare HHC patients are more likely than their White counterparts to lack access to primary care, and to have fewer resources to manage their chronic conditions despite receiving HHC, both of which may lead to greater risk for hospitalization.…”

Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study

“…A patient’s physical status influenced visit intensity. Other researchers established that patients with open wounds receive more nurse visits per week compared to those with other needs (Yeboah-Korang, Kleppinger, & Fortinsky, 2011). Few participants mentioned assessing the patient’s cognitive ability to evaluate the need for additional visits and reinforcement.…”