Adding this Step to Discharge Planning Slashes Hospital Readmissions by 25%

Including unpaid caregivers also leads to shorter rehospitalizations and lower costs of post-discharge care, researchers say.

Systematically integrating informal, unpaid caregivers into discharge planning for elderly patients was associated with 25% fewer readmissions at 90 days and 24% fewer readmissions at 180 days, according to a study published in the Journal of the American Geriatrics Society.

In control groups, no caregiver integration occurred.

"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," senior author A. Everette James, JD, MBA said in a statement.

James is director of the University of Pittsburgh's Health Policy Institute and its Stern Center for Evidence-Based Policy.

Seeking Value? Add Nonmedical Workers

Researchers at the University of Pittsburgh Health Policy Institute systematically reviewed 10,715 scientific publications related to patient discharge planning and older adults.

Their meta–analysis focused on the 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. Based on studies that included caregiver data, it was learned that:

• 66% of the caregivers were female
• 61% were a spouse or partner
• 35% were adult children

The research also found that most of the studies analyzed "reported statistically significant shorter time-to-readmission, shorter rehospitalization, and lower costs of post-discharge care among discharge planning interventions with caregiver integration," according to the abstract.

How 2 Systems Cut Postacute Care Costs and Raised Quality

"Due to medical advances, shorter hospital stays, and the expansion of home care technology, caregivers are taking on considerable care responsibilities for patients," lead author Juleen Rodakowski, OTD, MS, OTR/L, assistant professor in the Department of Occupational Therapy in Pitt's School of Health and Rehabilitation Sciences, said in a statement.

"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."

Caregiver statistics aggregated from the AARP, the Family Caregiver Alliance, the IOM, and the National Alliance for Caregiving reveal that:

• More than 34 million unpaid caregivers provide care to someone age 18 and older who is ill or has a disability (AARP, 2008)
• Unpaid caregivers provide an estimated 90% of the long-term care (IOM, 2008)
• The majority (83%) are family caregivers—unpaid persons such as family members, friends, and neighbors of all ages who are providing care for a relative (FCA, 2005)
• The typical caregiver is a 46-year-old woman with some college experience and provides more than 20 hours of care each week to her mother (NAC, 2004)

The studies examined by the University of Pittsburgh Health Policy Institute researchers varied in how caregivers were integrated.

Some interventions connected patients and caregivers to community resources. Others provided written care plans and medication reconciliation. Still others used learning validation methods, such as teach–back, where the caregiver demonstrates his or her training to an instructor, typically a nurse.

Reducing Readmissions From the Postacute Setting

The researchers say their findings validate the Caregiver Advise, Record and Enable (CARE) Act, which mandates caregiver identification and training before patients leave a health facility. Pennsylvania enacted it this week; it has so far been adopted by more than 30 states and the District of Columbia.