Newswise – Medicare patients with diabetes are more likely to be hospitalized again if they don’t receive recommended home health care within two days of being discharged, according to a Rutgers study.
The study was published as two articles in the International Journal of Environmental Research and Public Health.
The researchers found that 27 percent of 786,734 Medicare benefit recipients with a diabetes-related hospitalization received home health care within two weeks of their 2015 discharge. The results also showed that Hispanic and Native American patients were significantly less likely than white patients to be referred for home health care, and that ethnic minority and ethnic minority patients were more likely to receive late or no benefits within the first two weeks compared to non-Hispanic white patients .
The researchers found that the risk of re-hospitalization was significantly higher if recommended home health care began more than two days after hospital discharge. Patients who had a short delay in starting home health care within two days were 1.28 times more likely to be re-hospitalized than patients who started within the recommended time frame. Patients with longer delays had a 4.12-fold higher risk of re-hospitalization.
“Timely home health care can improve outcomes in older adults after hospital stays for diabetes, but we have found persistent racial / ethnic differences in who was referred to home health care and who received benefits in the critical first few days” , according to the study leader Olga F. Jarrín Montaner, assistant professor at the Rutgers School of Nursing and at the Rutgers Institute for Health, Healthcare Policy and Aging Research.
Depending on the needs of the patient, home health care by a registered nurse may include a comprehensive home health assessment, medication review and medication management assistance, care planning and coordination, individual training and assistance with dietary recommendations, assistance with blood monitoring, glucose, filling of Injecting insulin or treating complications of diabetes, including nerve damage to the hands and feet, stroke, cardiovascular disease, kidney damage, vision loss, cognitive impairment, and skin problems including non-healing wounds.
The researchers said there are several reasons why there might be inequalities in home health care utilization after discharge from hospital, such as cultural beliefs and practices in health care, preferred languages, health literacy, and other communication needs of older adults and their carers.
“As the COVID-19 pandemic reveals many inequalities in the health system, these challenges are exacerbated by systemic and structural issues that need to be critically examined from a social justice perspective,” said the study’s lead author, Jamie M. Smith, lecturer at Thomas Jefferson University, who worked on the project during her PhD at Rutgers. “Health organizations should prioritize integrating culturally congruent and linguistically appropriate practices into the care of older adults with diabetes in all health facilities.”
Researchers emphasized the importance of discharge planning, which also includes ensuring that patients and their families understand the purpose and value of home health care and assistance in overcoming structural and systemic barriers.
This research was supported by the National Institutes of Health’s National Institute on Aging, grants R01AG066139 and R24AG063729; National Center for Advancing Translational Sciences Grants UL1TR003017; and the Agency for Research and Quality in Health Care Scholarship R00HS022406. The authors are solely responsible for this content and do not necessarily reflect the official views of the National Institute on Aging of the National Institutes of Health, the National Center for Advancing Translational Sciences, or the Agency for Healthcare Research and Quality.
Co-authors of the two open access articles (sources below) are Haiqun Lin and Charlotte Thomas-Hawkins from the Rutgers School of Nursing, Tina Dharamdasani from the Rutgers School of Public Health and Jennifer Tsui from the University of Southern California Keck School Medicine.
Smith JM, Lin H, Thomas-Hawkins C, Tsui J, Jarrín OF. Timing of Home Health Care Initiation and 30-Day Re-Admissions of Medicare Beneficiaries with Diabetes by Race and Ethnicity. Int. J. Environment. Res. Public Health 2021, 18 (11), 5623. https://doi.org/10.3390/ijerph18115623
Smith JM, Jarrín OF, Lin H, Tsui, J, Dharamdasani T, Thomas-Hawkins C. Racial differences in referral and post-acute home health care utilization in older adults with diabetes. Int. J. Environment. Res. Public Health 2021, 18 (6), 3196. https://doi.org/10.3390/ijerph18063196