DIABETES IN THE AFRICAN-AMERICAN MEDICARE POPULATION - MORBIDITY, QUALITY OF CARE, AND RESOURCE UTILIZATION

OBJECTIVE-To determine whether African-American Medicare recipients wi th diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization. RESEARCH DESIGN AND METHODS-We analyze d 1,376 patients with diabetes who were greater than or equal to 65 ye ars of age and in the 1993 Medicare Current Beneficiary Survey. Morbid ity measures were the Katz Index of Activities of Daily Living, Instru mental 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 t ype of service and adjusted for sex, education, and age in multivariab le analyses. RESULTS-Compared with white patients, African-American pa tients had worse health perception and lower quality of care. They wer e more likely to visit the emergency department and had fewer physicia n visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix a djustment. CONCLUSIONS-Improved access to preventive care for older Af rican-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 am ong Medicare patients with diabetes should especially target African-A mericans.