Informal caregivers improve hospital discharge process, lower readmissions, study shows

Integrating informal caregivers into the discharge planning process for elderly patients could slash hospital readmissions by roughly 25 percent, says a new analysis from the University of Pittsburgh Health Policy Institute.

Informal caregivers are unpaid people who 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.

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

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The savings could be significant. Preventable hospital readmissions are estimated to account for more than $17 billion in Medicare expenditures each year, and some of those Medicare costs are passed on to hospitals in the form of penalties -- projected to cost about $528 million during the 2017 fiscal year. Under the Hospital Readmission Reduction Program, about half of all U.S. hospitals were hit with payment penalties last year.

Senior author A. Everette James, director of Pitt's Health Policy Institute and its Stern Center for Evidence-Based Policy, and his colleagues systematically reviewed 10,715 scientific publications related to patient discharge planning and older adults. 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.

Integrating caregivers into discharge planning resulted in a 25 percent reduction in risk of the elderly patient being readmitted to the hospital within 90 days, and a 24 percent reduction in risk of being readmitted within 180 days, when compared with control groups where no integration occurred.

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The studies varied in how they integrated caregivers, with interventions including 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.

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

"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 James in a statement.

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

Caregivers are typically family members of the discharged patient, but these responsibilities also may fall on friends, partners, neighbors and other loved ones. A recent Congressional Budget Office analysis found that caregivers provide 80 percent of all community-based long-term services and support for older adults.

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

Twitter: @JELagasse