Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

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

Producing Systematic Reviews Of Interventions In Speech–Language Pathology: A Framework For Sustainability

Systematic reviews in the health and social sciences are increasingly recognized as a valuable scientific tool to support decision making by clinicians, managers, administrators, and policy makers. Numerous organizations have arisen to fulfill growing demand for high-integrity systematic reviews with practical applications, each with a unique model for their review production process. This paper presents the results of a purposive sample of current production models in use by organizations engaged in the production of systematic reviews to support evidence-based practice. This paper also evaluates elements of review production such as major review steps, evidence standards, resource use, and cost. The results provide a potential framework for organizing resources to conduct systematic reviews. Applying this framework, producers can identify key areas of systematic-review production with the best fit between individual production models and their organization\u27s mission and policy environment. © 2007 Taylor & Francis Group, LLC