Medicare patients with diabetes are more likely to be sent back to the hospital if they do not receive home health services within two days of discharge from an acute setting, new research has found.
The findings have important implications for post-acute care planning, especially considering that roughly one in five Medicare beneficiaries 65 and older is affected by diabetes, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
But while timely home health care is an important tool for lowering re-hospitalization rates, clear barriers to service exist for certain demographic groups, the research additionally found.
“Timely home health care can improve outcomes in older adults following diabetes-related hospitalizations, but we found persistent racial/ethnic disparities exist in who was referred to home health care and who ended up receiving services within the critical first days,” Olga F. Jarrín Montaner, an assistant professor at Rutgers School of Nursing and the principal researcher, said in a statement.
The new research was published as two papers in the International Journal of Environmental Research and Public Health. In addition to multiple researchers from Rutgers, the project also included a researcher from the University of Southern California.
Overall, 27% of the nearly 790,000 Medicare beneficiaries with a diabetes-related hospital admission received home health care within two weeks of being discharged in 2015, the research determined. A patient’s risk of re-hospitalization was significantly higher when recommended home health care started more than two days after hospital discharge.
Specifically, patients who had a short delay of three to seven days in beginning home health care following an acute care discharge were 1.28 times more at risk of re-hospitalization compared to similar patients who started within two days.
Patients with delays of eight to 14 days were 4.12 times more at risk of re-hospitalizations.
“Effective post-acute home health care services can mitigate the risks of adverse events with prompt clinical assessment to address deterioration in condition and medication reconciliation,” one of the papers noted. “Furthermore, skilled home health care services can support patients with diabetes by evaluating and reinforcing diabetes self-management skills, medication management, nutritional support and glucose monitoring to prevent complications.”
Diabetes accounted for roughly 24% of in-patient spending and 21% of home health care spending in the U.S. in 2017, the research explained.
When it comes to racial and ethnic disparities, the researchers found that Hispanic and American Indian patients were “significantly less likely” to be referred to home health care compared to white patients. Additionally, racial and ethnic minority patients more often received delayed services — or no services at all — within the first two weeks after hospital discharge compared to non-Hispanic white patients.
Preferred languages, health literacy and other communication needs of older adults and their caregivers could partly explain the differences between population groups.
Cultural health beliefs and practices could likewise play a role, the researchers pointed out.
“With the COVID-19 pandemic highlighting many inequities in the health care system, these challenges are compounded by systemic and structural problems that need to be critically examined through a lens of social justice and equity,” Jamie M. Smith, an instructor at Thomas Jefferson University and the study’s lead author, said in a statement. “Health care organizations should prioritize incorporating culturally congruent and linguistically appropriate practices in the care of older adults with diabetes across healthcare settings.”
Smith worked on the project during her doctoral studies at Rutgers.
Companies featured in this article:
International Journal of Environmental Research and Public Health, Rutgers School of Nursing, University of Southern California
