Abstract
Proposed Medicare regulations require hospitals to engage caregivers in the discharge planning processes. The purpose of this meta-analysis was to examine the influence of integrating caregivers into discharge planning process on hospital readmission rates among older adults. We searched MEDLINE, EMBASE and the Cochrane Library databases for all English language articles published between 1990 and April 2016. We included randomized trials that examined discharge-planning interventions from hospitals to the community for older adults. All included interventions began prior to patient discharge, addressed at least one discharge planning element with a caregiver, and evaluated efficacy of discharge plan elements on hospital readmissions. We incorporated two levels of screening by three primary reviewers on 10,715 references. Study quality was assessed with the Cochrane risk of bias tool. We used a random-effects meta-analysis of pooled data to assess effect of the discharge planning interventions on hospital readmission rates. Fifteen studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control. Discharge planning with caregiver inclusion was 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]) compared to controls. The inclusion of caregivers into the discharge planning process reduces the risk of hospital readmission rates for older, hospitalized adults. These findings suggest that policies that incentivize and require inclusion of caregivers may benefit the patients and payers.