Systematically involving elderly patients’ informal caregivers such as family members or friends into the hospital discharge process reduces readmissions by one-fourth, according to a new study by the University of Pittsburgh Health Policy Institute.
The findings validate the Caregiver Advise, Record and Enable (CARE) Act, which has been adopted by more than 30 states and the District of Columbia, and proposed Medicare regulations that require caregiver identification and training before patients leave a health facility.
Informal caregivers provide support for medical tasks and activities critical to the daily life and health of someone who had a recent hospital or nursing home stay. Caregivers provide 80 percent of all community-based long-term services and support for older adults, according to a recent analysis by the Congressional Budget Office.
“Due to medical advances, shorter hospital stays, and the expansion of home care technology, caregivers are taking on considerable care responsibilities for patients,” said lead author Juleen Rodakowski, O.T.D., M.S., O.T.R./L., assistant professor in the Department of Occupational Therapy in Pitt’s School of Health and Rehabilitation Sciences.
“This includes increasingly complex treatment, such as wound care, managing medications, and operating specialized medical equipment. With proper training and support, caregivers are more likely to be able to fulfill these responsibilities and keep their loved ones from having to return to the hospital.”
The researchers systematically reviewed 10,715 scientific publications related to patient discharge planning and older adults. They eventually focused on 15 publications describing randomized control trials that included enough relevant information and data to draw insights into the influence of discharge planning on hospital readmissions.
The studies included 4,361 patients with an average age of 70 years. Two-thirds of the caregivers were female, and 61 percent were a spouse or partner, while 35 percent were adult children, based on studies that included caregiver data.
Involving caregivers in the discharge planning of elderly patients led to a 25 percent reduced risk of hospital readmission within 90 days, and a 24 percent reduced risk of readmission within 180 days, compared to control groups where no such integration occurred.
The studies varied in how they involved caregivers. The interventions included connecting patients and caregivers to community resources, providing written care plans and medication reconciliation, and using learning validation methods, such as teach-back, where the caregiver demonstrates his or her training to an instructor, typically a nurse.
“While integrating informal caregivers into the patient discharge process may require additional efforts to identify and educate a patient’s family member, it is likely to pay dividends through improved patient outcomes and helping providers avoid economic penalties for patient readmissions,” said senior author A. Everette James, J.D., M.B.A., director of Pitt’s Health Policy Institute and its Stern Center for Evidence-Based Policy.
The findings are published in the Journal of the American Geriatrics Society.