title: Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization.
abstract: OBJECTIVE
  To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization.
  
  
  METHODS
  We analyzed 1,376 patients with diabetes who were > or = 65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses.
  
  
  RESULTS
  Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment.
  
  
  CONCLUSIONS
  Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.
authors.affiliation: Section of General Internal Medicine, University of Chicago, Illinois 60637, USA. mchin@medicine.bsd.uchicago.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Chin
authors.forename: J X
authors.initials: JX
authors.lastname: Zhang
authors.forename: K
authors.initials: K
authors.lastname: Merrell
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000208:ethnology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011787:Quality of Health Care / Q000592:standards; D012923:Social Class; D014481:United States