Transitions in Care for Rural Medicare Beneficiaries with Diabetes

Funder:	Office of Rural Health Policy (ORHP)
Research center:	South Carolina Rural Health Research Center Phone: 803.251.6317
Lead researcher:	Janice C. Probst, PhD
Contact:	Kevin Bennett, PhD, 803.251.6317, Kevin.Bennett@sc.edu
Project funded:	September 2007
Project completed:	July 2011
Topics:	Chronic diseases and conditions Health disparities Medicare Minority health

Hospital admission rates for diabetes have been declining over the past 20 years. However, the degree to which improvements in care have reached rural as well as urban populations, and the degree to which improvements may have affected race-based health disparities, is not known. Identifying gaps in care can help rural providers and policy makers better direct resources for improvement.

The study will provide quantitative information regarding the effects of rural residence and minority race/ethnicity on care for persons with diabetes: specifying admission rates for diabetes among Medicare beneficiaries, ascertaining the proportion of hospitalized persons who transition appropriately to outpatient care, and examining factors related to re-hospitalization within a short period of time.

We will use data from the Medicare Chronic Conditions Data Warehouse (CCW) to study hospitalization and transition to care among beneficiaries. The analysis will examine outcomes in a cohort of beneficiaries with diabetes, followed over the 2000 - 2005 period, excluding beneficiaries who may be impaired in their ability to access diabetes care (persons in long term care, persons with cognitive impairment) or who suffer from end stage renal disease.

A technical report to ORHP will be generated. Key findings and the executive summary of the report will posted on the South Carolina Rural Health Research Center website.

Publications

• Handling the Handoff: Rural and Race-Based Disparities in Post Hospitalization Follow-up Care Among Medicare Beneficiaries with Diabetes
  Author(s): Kevin J. Bennett, Robert Chen, Medha Vyavaharkar, Saundra H. Glover, Janice C. Probst
  Date: 09 / 2011
  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.
• Handling the Handoff: Rural and Race-Based Disparities in Post-Hospitalization Follow-Up Care Among Medicare Beneficiaries with Diabetes (Fact Sheet)
  Date: 10 / 2011
  Uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America.