Disparities in Postdischarge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure

Disparities in postdischarge follow-up and risk of readmission between Medicaid and privately insured patients

BACKGROUND

Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow-up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow-up reduces risk of readmission for patients with Medicaid.

OBJECTIVE

To assess whether follow-up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status.

METHODS

This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow-up, and readmission. We analyzed data from 4281 patients aged 21-64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission. Outpatient follow-up within 30 days of discharge and 30-day all-cause readmission were outcomes.

RESULTS

Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow-up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow-up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91-1.32) in the overall sample or in analysis stratified by payer.

CONCLUSIONS

We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow-up. Timely follow-up care alone may not be sufficient as an intervention to reduce readmissions.

The Impact of Living in a Low Food Access/Low Income Area on Obstructive Sleep Apnea

OBJECTIVE

To assess differences in obstructive sleep apnea (OSA)-related health parameters between residents of low income/low access (LILA) census tracts-food deserts-and non-LILA residents STUDY DESIGN: Retrospective review.

SETTING

Single institution serving a large region in Southern California from 2017 to 2023.

METHODS

Census tracts are defined as LILA if a significant proportion of residents live below the poverty threshold and far from healthy food vendors. Adults newly diagnosed with OSA on polysomnography were included. Food access status was determined by searching patient addresses in the US Department of Agriculture Food Access Research Atlas. Baseline and 1-year follow-up body mass index (BMI) and vitals were collected and compared based on food access and other demographic variables.

RESULTS

A total of 379 patients in the LILA+ group and 2281 patients in the LILA- group met inclusion criteria. BMI was higher in the LILA group (36.6 ± 9.4 vs 35.2 ± 8.9; P = .006). The effect of food access was most significant in certain demographic groups: patients aged < 65, males, Asian/Pacific Islanders, Hispanics, and patients with Medicaid coverage all had a higher BMI when in the LILA+ group compared to the LILA- group. When considering insurance, LILA+ patients with Medicaid coverage had a significantly higher BMI than LILA- patients with non-Medicaid coverage (40.4 ± 10.3 vs 34.2 ± 8.4, P < .001. Blood pressure, heart rate, and apnea-hypopnea index were also significantly higher in LILA+/Medicaid group. BMI change across all demographic groups was minimal at 1-year follow-up.

CONCLUSION

Living in a LILA census tract may result in worse OSA-related health parameters. When accounting for insurance status, the effects are even more profound. Intensive counseling on the importance of weight management should begin at the diagnosis of OSA.