Medicaid beneficiaries with diabetes, HF often do not receive best care after discharge
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Key takeaways:
- Many Medicaid beneficiaries with diabetes and HF in Alabama did not have a timely follow-up visit after hospitalization.
- There were racial and ethnic disparities in who did and did not have a timely visit.
Among Medicaid beneficiaries with diabetes and heart failure in Alabama, many did not have a follow-up visit within 14 days of hospitalization in accordance with guidelines, researchers reported.
There were racial and ethnic disparities in who had a visit, whether it was within 14 days after hospitalization and whether it was to a primary care physician, according to the researchers.
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The study “likely demonstrates system-related factors, such as problems in the transitions of care between hospitals and clinics, and also structural racism that exists in the health care system,” Yulia Khodneva, MD, PhD, an assistant professor of medicine and a PCP at the University of Alabama School of Medicine in Birmingham, said in a press release. “The study underscores a necessity to develop interventions that will facilitate guideline-directed treatment and care for patients with type 2 diabetes and heart failure, especially for those with Medicaid or people of underrepresented races and ethnicities.”
HF guidelines and scientific statements recommend that patients with HF have an ambulatory follow-up 7 to 14 days after hospitalization for any reason, according to the study background.
The researchers analyzed 9,859 Medicaid-covered adults in Alabama with type 2 diabetes (mean age, 54 years; 65% women; 47% Black; 11% Hispanic, American Indian, Pacific Islander or Asian) who had a first hospitalization for HF from 2010 to 2019 to determine how much of that population had a follow-up visit in accordance with guideline recommendations.
Among the cohort, 26.7% had a follow-up visit within 0 to 7 days, 15.2% had one within 8 to 14 days, 31.3% had one within 15 to 60 days and 26.8% had no visit, Khodneva and colleagues found.
Among those who had a visit, 71% saw a PCP and 12% saw a cardiology physician, according to the researchers.
Compared with white adults, Black and Hispanic/American Indian/Pacific Islander/Asian adults were less likely to have any ambulatory visit after discharge (P < .0001), and were more likely to have a delayed visit (Black adults, by 1.8 days vs. white adults; P = .0006; Hispanic/American Indian/Pacific Islander/Asian adults, by 2.8 days vs. white adults; P = .0016), Khodneva and colleagues found.
In addition, compared with white adults, Black adults were less likely to see a PCP (incidence rate ratio [IRR] = 0.96; 95% CI, 0.91-1), as were Hispanic/American Indian/Pacific Islander/Asian adults (IRR = 0.91; 95% CI, 0.89-0.89), the researchers wrote.
Women were more likely than men to have any visit, and had their visits sooner than men by 1.9 days, according to the researchers.
“Hopefully, this study will trigger additional, more in-depth studies that may help to explain the reasons for these observed racial disparities and help in the development of interventions to promote prompt follow-up for these patients,” Khodneva said in the release.
Reference:
- Lack of timely follow-up after heart failure hospitalization for most adults with diabetes. https://newsroom.heart.org/news/lack-of-timely-follow-up-after-heart-failure-hospitalization-for-most-adults-with-diabetes. Published June 7, 2023. Accessed June 7, 2023.
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