Handling the Handoff: Rural and Race-Based Disparities in Post-Hospitalization Follow-up Care among Medicare Beneficiaries with Diabetes.

摘要

Diabetes is one of the most common chronic diseases, affecting an estimated 23.6 million people in the United States (7.8% of the total population). Rural African American and Hispanic residents with diabetes are less likely to exhibit good control of their condition, putting them at greater risk for the consequences of this disease, such as kidney failure, blindness and amputation. Effective outpatient care is key to diabetes management. Absence of such care, conversely, may play a role in poorer diabetes control in rural areas. The present report uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America. It provides estimates of hospital admission rates for rural Medicare beneficiaries with diabetes, tracks the proportion of patients who receive adequate outpatient care post discharge, and assesses subsequent readmissions to the hospital. It also explores the potential for race-based disparities in care for diabetes. The data were obtained from the 2005 Medicare claims data from the Chronic Condition Warehouse (CCW), merged with the 2007 Area Resource File (ARF). The study population was limited to beneficiaries who did not die during the year and did not have one of the following diagnoses: Alzheimers disease, dementia, schizophrenia, congestive heart failure, chronic kidney disease or end stage renal disease. Beneficiaries were also excluded if they were discharged to a long term care facility, another hospital, hospice or with home health services. Thus, only beneficiaries who were not hospitalized during the study year, or who were hospitalized and discharged back into the community after hospitalization, are included in the study.