title: Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis.
abstract: OBJECTIVE
  To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults.
  
  
  METHODS
  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.
  
  
  METHODS
  Hospital or skilled nursing facility.
  
  
  METHODS
  Older adults with informal caregivers discharged to a community setting.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission.
authors.affiliation: School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Juleen
authors.identifier: http://orcid.org/0000-0002-6397-8124
authors.initials: J
authors.lastname: Rodakowski
authors.affiliation: Department of Political Science, Marquette University, Milwaukee, Wisconsin.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Rocco
authors.affiliation: Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Maqui
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Barbara
authors.initials: B
authors.lastname: Folb
authors.affiliation: University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.affiliation: College of Science, Virginia Polytechnic Institute and State University, Blacksburg, Virginia.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Morton
authors.affiliation: Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, District of Columbia.
authors.forename: Sally Caine
authors.initials: SC
authors.lastname: Leathers
authors.affiliation: School of Medicine, New York University, New York, New York.
authors.forename: Lu
authors.initials: L
authors.lastname: Hu
authors.affiliation: Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.|Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: A Everette
authors.initials: AE
authors.lastname: James
mesh_terms: D017028:Caregivers / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006801:Humans; D010351:Patient Discharge; D010359:Patient Readmission; D016032:Randomized Controlled Trials as Topic
keywords: caregiver; cost; discharge planning; resource use