Accountable Care Organizations and Health Disparities of Rural Latinos: A Longitudinal Analysis.

The purpose of this study was 2-fold: (1) to analyze the change in diabetes-related hospitalization rates of rural Latino older adult patients as compared with their White counterparts and (2) to determine what factors, including rural health clinic (RHC) participation in accountable care organizations (ACOs), are related to reduced disparities in diabetes-related hospitalization rates. Data for Latino Medicare beneficiaries who were served by RHCs over an 8-year period were analyzed. First, a difference-of-means test was conducted to determine whether there was a change in disparity from the pre-ACO period (2008-2011) to the post-ACO period (2012-2015). A statistically significant decrease in disparity over time was found (t = -7.6899, df = 115, P < 0.001.) Second, multiple regression analyses of 3 separate models were conducted to determine whether ACO participation contributed to reducing disparities in diabetes-related hospitalization rates between Latinos and Whites. The analyses indicated moderate evidence that consistent ACO participation is associated with lower health disparities (t = -1.947, P = 0.0525). However, this association is not significant after balancing covariates, and no causal relationship can be established. Latinos compose one of the fastest growing groups in rural as well as urban areas of the United States. It is critical that ACOs, with their emphasis on care coordination, health care quality, and value, monitor their provision of services to Latinos, rural, and other vulnerable populations.

Trends in Health Disparities of Rural Latinos Pre- and Post-Accountable Care Organization Implementation.

Purpose: We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts. Methodology/Approach: A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008 - 2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period. Findings: Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of "ACO RHCs," there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel. Research limitations/implications: There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs. Originality/Value of Paper: This paper presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The U.S. Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the U.S. healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

Healthcare Needs of U.S. Rural Latinos: A Growing, Multicultural Population.

PURPOSE: From 2000 to 2050, the Latino population in the United States (U.S.) is expected to grow by 273%. Health outcomes vary widely among Latino subgroups and health disparities more adversely affect rural residents. The commonly used "one-size-fits-all" approach assumes that the U.S. Latino population is homogeneous. SAMPLE METHOD: Rural Latinos in four study states: Arizona (AZ), California (CA), Florida (FL) and Texas (TX) were the focus of this study. This research describes changes in the Latino population in rural counties of the U.S. in two dimensions: 1) change in population by number, and 2) change in population by country of origin using data from 2000-2017. FINDINGS: The following themes emerged: 1) the overall Latino population grew in each state; 2) rural Latino populations in each state also increased but at a higher rate; 3) there is a variety of diversity in the countries of origin of rural Latinos based in each state; and 4) a considerable proportion of Latinos living in rural areas are of unknown Latino origins. CONCLUSIONS: As the largest racial or ethnic minority in rural populations and as the second largest group in the nation, Latino health has a significant influence on the U.S. healthcare system. For nurses, evidence-based strategies can be tailored to address diverse Latino subpopulations to reduce specific disparities for various ethnic populations.