Among Medicare beneficiaries with diabetes, does post-acute home health care use reduce the risk of rehospitalization?

Diabetes affects more than one-quarter of older adults living in the United States. Patients with diabetes are at increased risk of adverse outcomes due to medication changes and exacerbated co-occurring conditions following hospitalizations. Post-acute home health care can support safe transitions home with clinical assessments, medication reconciliation, and reinforcement of self-management skills. The extent to which race/ethnicity and societal factors affect access to home health care and rehospitalization risk has not been fully explored. Therefore, the study's purpose was to 1) examine the association between race/ethnicity, hospital discharge referral, and subsequent use of home health care; and 2) explore the relationship between the timing of home health initiation and 30-day rehospitalization risk following diabetes-related hospitalizations. This dissertation was a cohort analysis of Medicare fee-for-service and Medicare Advantage beneficiaries who experienced a diabetes-related hospitalization in 2015 and were discharged home with or without home health services. The study used Medicare administrative, claims, and assessment data. The analytic approach included using multivariate logistic regression models to assess for predictors of home health referral and use within 14 days of hospital discharge. Then multivariate logistic regression models included patient demographics, clinical, and geographic variables to evaluate the relationship between the timing of home health care initiation and 30-day rehospitalizations. Inverse probability weighted propensity scores were incorporated to account for potential confounding factors.Racial/ethnic differences were uncovered in home health referral and use. In the fully adjusted models, Hispanic and American Indian/Alaska Native patients were 20% less likely to be referred to home health than white patients (p