Home Health Care Services Reduce Re-hospitalizations for Medicare Patients with Diabetes

Medicare patients with diabetes are more likely to be re-hospitalized if they do not receive recommended home health care within two days of discharge, according to a Rutgers study.

The study was published as two papers in the International Journal of Environmental Research and Public Health.

The researchers found that 27 percent of 786,734 Medicare beneficiaries with a diabetes-related hospital admission received home health care within two weeks of being discharged in 2015. The results also showed that Hispanic and American Indian patients were significantly less likely than white patients to be referred to home health care, and that racial and ethnic minority patients more often received delayed services or no services within the first two weeks compared to non-Hispanic white patients.

The researchers found that a patient’s risk of re-hospitalization was significantly higher when recommended home health care started more than two days after hospital discharge. Patients who had a short delay in beginning home health care within two days were 1.28 times more at risk of re-hospitalization compared to patients who began within the recommended timeframe. Patients with delays beyond that were 4.12 times more at risk of re-hospitalizations.

“Timely home health care can improve outcomes in older adults following diabetes-related hospitalizations, but we found persistent racial/ethnic disparities exist in who was referred to home health care and who ended up receiving services within the critical first days,” said the study’s principal investigator Olga F. Jarrín Montaner, an assistant professor at Rutgers School of Nursing and Rutgers Institute for Health, Healthcare Policy, and Aging Research.

Depending on a patient’s needs, home health care provided by a registered nurse may include a comprehensive in-home health assessment, medication review and assistance with medication management, care planning and care coordination, individualized education and assistance with dietary recommendations, assistance with monitoring blood glucose, filling insulin syringes, or managing complications of diabetes, including nerve damage in hands and feet, stroke, cardiovascular disease, damage to kidneys, vision loss, cognitive impairment and skin problems, including non-healing wounds.

The researchers said there were multiple reasons why disparities in receiving home health care services after hospital discharge might occur, such as cultural health beliefs and practices, preferred languages, health literacy and other communication needs of older adults and their caregivers.

“With the COVID-19 pandemic highlighting many inequities in the health care system, these challenges are compounded by systemic and structural problems that need to be critically examined through a lens of social justice and equity,” said the study’s lead author Jamie M. Smith, an instructor at Thomas Jefferson University who worked on the project during her doctoral studies at Rutgers. “Health care organizations should prioritize incorporating culturally congruent and linguistically appropriate practices in the care of older adults with diabetes across healthcare settings.”

The researchers emphasized the importance of discharge planning that includes ensuring patients and their families understand the purpose and value of home health care and assistance navigating structural and systemic barriers.

The study, which included a researcher from the University of Southern California, was co-authored by Haiqun Lin and Charlotte Thomas-Hawkins of the Rutgers School of Nursing and Tina Dharamdasani of the Rutgers School of Public Health. The study was funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.