Caregivers improve discharge process, decrease readmissions, study finds


Incorporating informal caregivers into the discharge planning process for elderly patients could reduce hospital readmissions by about 25%, according to new analysis from the Health Policy Institute at the University of Pittsburgh.

Caregivers are unpaid individuals who provide support for medical tasks and activities essential to the daily life and health of a person who has recently been in a hospital or nursing home.

The study, published in the Journal of the American Geriatrics Society, is the first to quantify the impact of integrating caregivers into discharge planning on healthcare costs and resource use.

[Also: Providers that help patients manage chronic conditions face fewer readmission penalties]

The savings could be significant. Avoidable hospital readmissions are estimated to account for over $ 17 billion in Medicare spending each year, and some of those Medicare costs are passed on to hospitals in the form of penalties – which are expected to cost around $ 528 million over the course of this year. fiscal year 2017. As part of the Hospital Readmission Reduction Program, about half of all US hospitals were hit with payment penalties last year.

Lead author A. Everette James, director of Pitt’s Health Policy Institute and its Stern Center for Evidence-Based Policy, and colleagues systematically reviewed 10,715 scientific publications related to discharge planning for patients and the elderly. The studies included 4,361 patients with a mean age of 70 years. Two-thirds of caregivers were women and 61 percent were a spouse or partner, while 35 percent were adult children, based on studies that included data on caregivers.

Incorporating caregivers into discharge planning resulted in a 25% reduction in the risk of the elderly patient being readmitted to hospital within 90 days and a 24% reduction in the risk of being readmitted within 180 days, e.g. compared to control groups where no integration took place.

[Also: Affordable Care Act penalties pay dividends in readmissions reductions]

Studies varied in how they integrated caregivers, with interventions including connecting patients and caregivers with community resources, providing written care plans and medication reconciliation, and using methodologies. validation of learning, such as apprenticeship, where the caregiver demonstrates their training to an instructor, usually a nurse.

The finding validates the Caregiver Advise, Record and Enable Act, which has been passed by more than 30 states and the District of Columbia, and proposed in Medicare regulations that require identification and training of caregivers before patients leave a health facility.

“While integrating caregivers into the patient discharge process may require additional efforts to identify and educate a patient’s family member, it is likely to bear fruit in improving patient outcomes and helping providers avoid economic penalties for patient readmissions, ”James said in a statement.

[Also: Hospitals serving disadvantaged patients need special consideration for readmission penalties]

Caregivers are usually family members of the released patient, but these responsibilities may also fall on friends, partners, neighbors and other relatives. A recent analysis by the Congressional Budget Office found that caregivers provide 80% of all long-term community services and supports to older people.

The research was funded by the Stern Family Foundation and the Emily Kelly Roseburgh Memorial Fund of the Pittsburgh Foundation.

Twitter: @JELagasse


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