OBJECTIVES: To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults.
DESIGN: A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use 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 postdischarge care.
RESULTS: Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62-0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64-0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration.
CONCLUSION: For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission.
It is not surprising that the inclusion of caregivers into the discharge planning process reduces hospital readmission rate. The interesting aspect of this review is that it doesn't seem to make a difference how caregivers are included.
This is a comprehensive and well done synthesis of the existing RCTs on the topic, with results consistent with the common clinical sense. As the authors recognize, the heterogeneity of the interventions in their design and components and the lack of relevant qualitative, organisational and contextual information, limit the immediate transferability of the results to one's own practice.
This is in line with the current movement towards providing patient/family-centered care. Including caregivers in discharge planning of older adults seems somewhat intuitive. This study provides some clear data and attempts to quantify how much of a benefit is actually likely. Pooled results are impressive; as is low heterogeneity, though quality of included studies may be a bit of an issue.
It is a pity that only relative risks are reported as measures of effect size. Also, the forest plots do not give the totals and the numbers of subjects with the outcome so one is left wondering what the absolute risk difference is.