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

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. Building on prior findings of racial/ethnic disparities in post-acute referral and utilization of home health, this study examined timing of home health care initiation and 30-day rehospitalization outcomes. Using linked Medicare administrative, assessment, and claims datasets (2014-2016), we identified 209,150 Medicare beneficiaries, age 50 and older, who were referred to post-acute home health following a diabetes-related index hospitalization. Multivariate logistic regression models included patient demographics, neighborhood area deprivation, and rural/urban setting. Home health care initiated within one week was associated with lower risk of 30-day rehospitalization (days 0-2, OR=0.88, 95% CI 0.86-0.91; days 3-7, OR=0.87, CI 0.84-0.90). In contrast, a late start of services (days 8-14) was associated with a higher risk of 30-day rehospitalization (OR=2.2, CI 2.0-2.3). This pattern of results was observed across all racial/ethnic patient groups. However, racial/ethnic minority patients were less likely to receive timely home health care services compared to white patients. Timely initiation and coordination of home health care is one strategy to improve outcomes following diabetes-related hospitalizations that benefits older adults of all racial/ethnic groups.