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

2021 ◽  
Author(s):  
Jamie M. Smith ◽  
Olga F. Jarrín ◽  
Haiqun Lin ◽  
Tina Dharamdasani ◽  
Jennifer Tsui ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Hospital Discharge ◽  
Home Health Care ◽  
The United States ◽  
Home Health ◽  
Urban Setting ◽  
Hospital Length Of Stay ◽  
Area Deprivation ◽  
Administrative Claims

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.

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

2021 ◽  
Vol 18 (6) ◽  
pp. 3196
Author(s):  
Jamie M. Smith ◽  
Olga F. Jarrín ◽  
Haiqun Lin ◽  
Jennifer Tsui ◽  
Tina Dharamdasani ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Hospital Discharge ◽  
Home Health Care ◽  
Ethnic Disparities ◽  
The United States ◽  
Home Health ◽  
Urban Setting ◽  
Administrative Claims ◽  
Racial Ethnic

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.

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

2021 ◽  
Author(s):  
Jamie M. Smith ◽  
Olga F. Jarrín ◽  
Haiqun Lin ◽  
Charlotte Thomas-Hawkins ◽  
Jennifer Tsui
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Health Care ◽  
Health Care Services ◽  
Home Health ◽  
Urban Setting ◽  
Medicare Beneficiaries ◽  
Timely Initiation ◽  
Care Services ◽  
Racial Ethnic

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. Building on prior findings of racial/ethnic disparities in post-acute referral and utilization of home health, this study examined timing of home health care initiation and 30-day rehospitalization outcomes. Using linked Medicare administrative, assessment, and claims datasets (2014-2016), we identified 209,150 Medicare beneficiaries, age 50 and older, who were referred to post-acute home health following a diabetes-related index hospitalization. Multivariate logistic regression models included patient demographics, neighborhood area deprivation, and rural/urban setting. Home health care initiated within one week was associated with lower risk of 30-day rehospitalization (days 0-2, OR=0.88, 95% CI 0.86-0.91; days 3-7, OR=0.87, CI 0.84-0.90). In contrast, a late start of services (days 8-14) was associated with a higher risk of 30-day rehospitalization (OR=2.2, CI 2.0-2.3). This pattern of results was observed across all racial/ethnic patient groups. However, racial/ethnic minority patients were less likely to receive timely home health care services compared to white patients. Timely initiation and coordination of home health care is one strategy to improve outcomes following diabetes-related hospitalizations that benefits older adults of all racial/ethnic groups.

Differences in Transitional Care Provided to Mexican American and Non-Hispanic White Older Adults

2016 ◽  
Vol 28 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Janice D. Crist ◽  
Kari M. Koerner ◽  
Joseph T. Hepworth ◽  
Alice Pasvogel ◽  
Catherine A. Marshall ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Health Care ◽  
Health Care Services ◽  
Transitional Care ◽  
Insurance Coverage ◽  
Home Health ◽  
Hospital Length Of Stay ◽  
Care Services ◽  
Hispanic White

Background:Transitional care, assisting patients to move safely through multiple health care settings, may be insufficient for older Hispanic patients. Purpose: Describe home health care services referral rates for Hispanic and non-Hispanic White (NHW) patients and factors that influence case managers’ (CMs’) discharge planning processes. Design: Organized by the Ethno-Cultural Gerontological Nursing Model, health records were reviewed ( n = 33,597 cases) and supplemented with qualitative description ( n = 8 CMs). Findings: Controlling for gender, insurance type, age, and hospital length of stay, NHW older adults received more home health care services referrals (odds ratio = 1.23). Insurance coverage was the most frequent determinant of CMs’ post–hospital care choices, rather than patients’ being Hispanic. NHW older adults were more likely to have insurance than Hispanic older adults. Implications: Insurance coverage being CMs’ primary consideration in determining patients’ dispositions is a form of systems-level discrimination for Hispanic vulnerable groups, which combined with other hospital-level constraints, should be addressed with policy-level interventions.

scholarly journals Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

2019 ◽  
Vol 7 (4) ◽  
pp. 561-569
Author(s):  
Jo-Ana D Chase ◽  
David Russell ◽  
Meridith Rice ◽  
Carmen Abbott ◽  
Kathryn H Bowles ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Family Caregivers ◽  
Learning Strategies ◽  
Home Health Care ◽  
Home Health ◽  
Barriers To Learning ◽  
Telephone Interviews ◽  
Qualitative Descriptive ◽  
Training And Support

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

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

2021 ◽  
Vol 18 (11) ◽  
pp. 5623
Author(s):  
Jamie M. Smith ◽  
Haiqun Lin ◽  
Charlotte Thomas-Hawkins ◽  
Jennifer Tsui ◽  
Olga F. Jarrín
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Race And Ethnicity ◽  
Health Care Services ◽  
Propensity Scores ◽  
The United States ◽  
Home Health ◽  
Medicare Beneficiaries ◽  
Timely Initiation ◽  
Care Services

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.

scholarly journals Characteristics Associated with Home Health Care Referrals at Hospital Discharge: Results from the 2012 National Inpatient Sample

2016 ◽  
Vol 52 (2) ◽  
pp. 879-894 ◽  
Author(s):  
Christine D. Jones ◽  
Heidi L. Wald ◽  
Rebecca S. Boxer ◽  
Frederick A. Masoudi ◽  
Robert E. Burke ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Home Health Care ◽  
Home Health ◽  
National Inpatient Sample

Depression Screening and Interventions for Older Home Health Care Patients

2011 ◽  
Vol 23 (6) ◽  
pp. 435-445 ◽  
Author(s):  
Colleen Delaney ◽  
Richard Fortinsky ◽  
Lorraine Doonan ◽  
Rita L. W. Grimes ◽  
Pearson Terra-Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Care ◽  
Home Health Care ◽  
Education Program ◽  
Self Efficacy ◽  
Home Health ◽  
Depression Screening ◽  
Program Outcomes ◽  
The Impact

The increasing prevalence of depression in elderly home health care patients led to a statewide initiative in Connecticut to enhance evidence-based depression treatment for older adults. A training curriculum on depression screening and interventions was developed and disseminated to 25 home care professionals representing 14 agencies in Connecticut using a train-the-trainer model. Home care trainers included nurses and social workers. This article describes Phase I curriculum design and initial evaluation of the impact of the training on the preparation of trainers to provide depression care education at their home care agencies. Several evaluation measures, including an appraisal of the self-reported attitudes and self-efficacy of home care professionals towards depressed older adults, a pre/post-test to assess the trainers’ knowledge, and willingness of trainers to implement the education program at their agencies were used to assess program outcomes. Participants’ self-efficacy levels in screening and caring for depressed older adults was significantly increased following the education program compared to immediately before the education program (t, (24) = -4.204; p < .001).

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