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April 10, 2017

Cutting readmissions gets easier when you bring in family, study finds

Daily Briefing

    Hospitals can cut readmission rates for elderly patients by integrating spouses, adult children, and other informal caregivers into the patients' discharge process, according to a new study published in the Journal of American Geriatrics.

    Researchers from the University of Pittsburgh (Pitt) Health Policy Institute conducted the study, which was funded by the Stern Family Foundation and the Emily Kelly Roseburgh Memorial Fund of The Pittsburgh Foundation. It is the first to quantify how integrating caregivers into the discharge process relates to health care costs and resource utilization, according to Pitt's School of the Health Sciences.

    Study details

    For the analysis, researchers reviewed 10,715 scientific publications assessing patient discharge plans and older adults. They found 15 studies qualified for inclusion in the analysis, which together involved a total of 4,361 patients with an average age of 70. Sixty-one percent of informal caregivers were a spouse or partner, and 35 percent were adult children.

    The studies examined various approaches to integrating caregivers, including:

    • Connecting patients and caregivers to community resources;
    • Giving written care plans; and
    • Using "learning validation methods," such as having a caregiver demonstrate their training in caregiving to an instructor.

    Caregiver integration cuts readmissions

    When compared with groups where caregivers were not integrated into the discharge process, the researchers found that caregiver integration resulted in a:

    • 25 percent reduction in the risk of an elderly patient being readmitted within 90 days; and
    • 24 percent reduction in the risk of an elderly patient being readmitted within 180 days.

    According to Healthcare Finance, the findings could be significant given that preventable hospital readmissions are estimated to account for more than $17 billion in annual Medicare expenditures, some of which are passed on to hospitals via penalties. Last year, about half of hospitals were penalized under the Hospital Readmission Reduction Program, and hospitals are projected to pay about $528 million in readmission penalties for fiscal year 2017.

    Caregiver integration 'likely to pay dividends,' researchers say

    Senior author A. Everette James, director of Pitt's Health Policy Institute and the Stern Center for Evidence-Based Policy, acknowledged that "integrating informal caregivers into the patient discharge process may require additional efforts to identify and educate a patient's family member." But James said doing so "is likely to pay dividends through improved patient outcomes and helping providers avoid economic penalties for patient readmissions."

    Juleen Rodakowski, assistant professor at Pitt's department of occupational therapy, said advances in medicine and technology mean "caregivers are taking on considerable care responsibilities." However, she added that "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" (Lagasse, Healthcare Finance News, 4/3; Zimmerman, Becker's Infection Control & Clinical Quality, 4/3; University of Pittsburgh Schools of the Health Sciences release, 4/3).

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