Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes.
Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes.
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DOI：
10.3390/ijerph18063196
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发表时间：
2021-03-19
影响因子：
--
通讯作者：
Thomas-Hawkins C
中科院分区：
文献类型：
--
作者：
Smith JM;Jarrín OF;Lin H;Tsui J;Dharamdasani T;Thomas-Hawkins C
在糖尿病患病率、卫生服务利用率以及结果，包括糖尿病患者的致残和危及生命的并发症方面，存在种族和民族差异。通过对患者及其照顾者的个性化教育、宣传、护理协调和心理社会支持，家庭卫生保健可能尤其有利于患有糖尿病的老年人。这项研究的目的是在一组经历过糖尿病相关住院的成年人(50岁及以上)中，研究种族/民族与出院到家庭医疗保健以及随后的家庭医疗保健利用之间的关系。这项研究仅限于在美国连续参加联邦医疗保险至少12个月的患者。队列(n=786,758)在他们的糖尿病相关指数住院后被跟踪14天，使用相关的医疗保险管理、索赔和评估数据(2014-2016)。多因素Logistic回归模型包括患者人口统计、合并症、住院时间、地理区域、社区剥夺和城乡环境。在完全调整的模型中，与白人患者相比，西班牙裔(OR 0.8，95%CI 0.8-0.8)和美国印第安人(OR 0.8，CI 0.8-0.8)患者出院到家庭医疗保健的可能性显著降低。在那些出院接受家庭保健的人中，所有非白人种族/少数民族患者在14天内接受服务的可能性较小。今后减少糖尿病住院患者急性后护理结果中的种族/族裔差异的努力应包括处理结构性种族主义和获得家庭保健服务的系统性障碍的政策和实践准则。
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.
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影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
Smith M
DOI：
10.1016/j.jamda.2018.08.016
发表时间：
2019-04-01
影响因子：
7.6
作者：
Bowles, Kathryn H.;Ratcliffe, Sarah J.;Naylor, Mary D.
通讯作者：
Naylor, Mary D.
影响因子：
2.5
作者：
Chen, Jie;DuGoff, Eva Hisako;Wang, Min Qi
通讯作者：
Wang, Min Qi
影响因子：
3.4
作者：
Durfey, Shayla N. M.;Kind, Amy J. H.;Trivedi, Amal N.
通讯作者：
Trivedi, Amal N.
影响因子：
3.4
作者：
Findling, Mary G.;Casey, Logan S.;Miller, Carolyn
通讯作者：
Miller, Carolyn