Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Abstract

OBJECTIVES To determine the effect of integrating informal caregivers into discharge planning on post-discharge cost and resource utilization in the older adult population. DESIGN A systematic review and meta-analysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun prior to patient discharge on healthcare cost and resource utilization outcomes. MEDLINE, EMBASE and the Cochrane Library databases were searched for all English language articles published between 1990 and April 2016. SETTING Hospital or skilled nursing facility. PARTICIPANTS Older adults with informal caregivers discharged to a community setting. MEASUREMENTS Readmission rates, length of and time to post-discharge rehospitalizations, costs of post-discharge care. RESULTS Of 10,715 abstracts identified, fifteen studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control. Compared to usual care, discharge planning interventions with caregiver integration were associated with a 25 percent reduction in readmissions at 90 days (Relative Risk [RR], .75 [95% CI, .62-.91]) and a 24 percent reduction in readmissions at 180 days (Relative Risk [RR], .76 [95% CI, .64–.90]). The majority of studies reported statistically significant reductions in time to readmission, length of rehospitalization, and costs of post-discharge care. CONCLUSION For older adult patients discharged to a community setting, the integration of caregivers into the discharge planning process, compared to non-systematic inclusion of caregivers, reduces the risk of hospital readmission.

Teaching a DISCHARGE Framework to Hospital Teams to Improve Transitions of Care

“…Next, the evidence for each DISCHARGE element was reviewed (17,(20)(21)(22)(23)25,26). Interventions for each domain were described to demonstrate potential patient impact.…”

“…To equip teams with a cognitive approach to discharging patients, we created an evidence-based framework based on prior literature, (13,(17)(18)(19)(20)(21)(22)(23)(24)(25) summarized as the acronym, "DISCHARGE:" Drugs, Identifying barriers, Self-management of diseases, Communication with primary care physicians (PCP) and caregivers, Home services, Appointments, Red ags signs, Go (Activity), and Educate (Teach) back.…”

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