194573 Racial Disparities in Use of Medicare Home Health Care Among Patients with Diabetes

Tuesday, November 10, 2009: 8:30 AM

Amoah Yeboah-Korang , School of Medicine, University of Connecticut Health Center, New Britain, CT
Richard Fortinsky, PhD , Center on Aging, University of Connecticut Health Center, Farmington, CT
Purpose: Health disparities are found among racial groups across many health services, but little is known about disparities in Medicare home health care (HHC). Due to the importance of HHC to diabetes patients, and consistent with efforts to better understand and minimize racial disparities in health service use, we examined whether and how racial disparities exist in HHC use in a national sample of Medicare patients with diabetes.

Methods: Medicare HHC claims were linked to Outcome and Assessment Information Set data in a 20% random sample of Medicare beneficiaries who completed HHC episodes in 2002. Inclusion criteria for this study were self reported identity as Caucasian, African-American, Hispanic, or Asian; and a primary HHC diagnosis of type II diabetes. HHC use measures were: number of visits and visits per week by nurses, physical therapists, home health aides, and all 6 Medicare HHC clinical disciplines combined.

Results: Racial distribution of the sample (n=9,838) was: 62% Caucasian, 22% African American, 12% Hispanic, and 3% Asian. Controlling for numerous health-related and sociodemographic covariates, compared to Caucasian patients: African-Americans received more home health aide visits but fewer visits per week from nursing, physical therapy, and all clinical disciplines combined; Hispanics received more nursing visits and more visits from all disciplines (all differences p<0.001); Asians received equivalent amounts of all types of HHC visits.

Conclusions: African-American Medicare HHC patients with diabetes received less skilled care and more unskilled care than Caucasians, suggesting disparities in the use of the Medicare HHC benefit for diabetes care.

Learning Objectives:
Describe how racial disparities exist in home health service use in a nationally representative sample of Medicare patients with diabetes.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceived the idea for the research, sorted the data, analyzed the data and wrote the report.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.