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Article

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

1
College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA
2
School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA
3
School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
4
Keck School of Medicine of USC, University of Southern California, Los Angeles, CA 90033, USA
5
Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Ronica N. Rooks, Cassandra D. Ford and Arlesia L. Mathis
Int. J. Environ. Res. Public Health 2021, 18(11), 5623; https://doi.org/10.3390/ijerph18115623
Received: 4 April 2021 / Revised: 19 May 2021 / Accepted: 21 May 2021 / Published: 25 May 2021
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. View Full-Text
Keywords: chronic conditions; diabetes; older adults; race or ethnicity; social determinants of health; inequalities or inequities; policy; health care access; home health care; rehospitalization chronic conditions; diabetes; older adults; race or ethnicity; social determinants of health; inequalities or inequities; policy; health care access; home health care; rehospitalization
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MDPI and ACS Style

Smith, J.M.; Lin, H.; Thomas-Hawkins, C.; Tsui, J.; Jarrín, O.F. Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity. Int. J. Environ. Res. Public Health 2021, 18, 5623. https://doi.org/10.3390/ijerph18115623

AMA Style

Smith JM, Lin H, Thomas-Hawkins C, Tsui J, Jarrín OF. Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity. International Journal of Environmental Research and Public Health. 2021; 18(11):5623. https://doi.org/10.3390/ijerph18115623

Chicago/Turabian Style

Smith, Jamie M., Haiqun Lin, Charlotte Thomas-Hawkins, Jennifer Tsui, and Olga F. Jarrín 2021. "Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity" International Journal of Environmental Research and Public Health 18, no. 11: 5623. https://doi.org/10.3390/ijerph18115623

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