Date of Completion


Embargo Period



Joan Segal; David Gregorio

Field of Study

Public Health


Master of Public Health

Open Access

Campus Access


Purpose: Due to the importance of Medicare home health care (HHC) to beneficiaries when complications of diabetes mellitus result in the need for skilled home care and consistent with efforts to better understand and minimize racial disparities in patterns of HHC service use, we compared racial and ethnic groups across measures of HHC service use in a nationally representative sample of Medicare HHC beneficiaries with a primary diagnosis of type 2 diabetes mellitus. Methods: Medicare HHC claims were linked to Outcome and Assessment Information Set data in a 20% stratified random sample of Medicare beneficiaries who completed HHC episodes in 2002. Inclusion criteria for this study were self-reported identity as White, African American, Hispanic, or Asian; and a primary HHC diagnosis of type 2 diabetes mellitus. HHC use measures were: visits per week by nursing, physical therapy, home health aide, and all HHC clinicians combined (including occupational therapy, speech therapy, and medical social work). Results: Racial and ethnic group distribution of study sample (N=9,838) was: 62% White, 22% African American, 12% Hispanic, and 3% Asian. Controlling for numerous health-related and sociodemographic covariates, African Americans as compared to Whites received fewer nurse visits per week and fewer visits per week from all clinical staff combined (p < 0.001); Hispanics as compared to Whites were less likely to receive physical therapy (adjusted odds ratio (AOR) = 0.640, 95% confidence interval (CI) = 0.543-0.754, p < 0.001) or home health aide (AOR = 0.716, 95% CI = 0.582-0.880, p = 0.002) services. There were no statistically significant differences in service use measures between African Americans and Hispanics. Conclusions: Hispanic and African American Medicare HHC beneficiaries with type 2 diabetes mellitus received less rehabilitation and fewer skilled nursing services.

Major Advisor

Richard Fortinsky