By Christopher Cheney
For adult patients living with chronic illness, home caregiver engagement plays a significant role in patient outcomes during the transition of care from hospital to home, a recent research article found.
Several earlier studies have shown negative impacts on adults with chronic conditions during healthcare transitions. About 26% of these patients experience emergency department visits, 18% experience rehospitalizations, 66% experience adverse drug events, and 81% experience medication discrepancies.
The recent research article, which was published by Medical Care, examines the findings of more than 50 studies of transitional care interventions. The study includes two key data points:
- In studies that involved home caregiver engagement in transitional care interventions, the overall likelihood of hospital readmissions was reduced by 17%
- Transitional care interventions that did not have caregiver engagement in the components of the interventions did not have significant impacts on hospital readmissions
“Whether in research or clinical practice, transitional care should not be conducted without careful consideration of where and how caregivers will be incorporated and supported as active partners in optimizing patient care across healthcare transitions,” the study’s co-authors wrote.
Forms of home caregiver engagement
Healthcare providers can engage home caregivers, who include family members and friends, in several ways, the lead author of the recent research article says.
“When we think about engaging home caregivers, we need to adequately support them beyond just information provision. Caregiver engagement truly involves not just giving them information but also understanding what their preferences and needs are. We also need to collaborate with them to develop the plan of care. That is the way that care gets personalized. Engagement can take the form of understanding what caregivers’ needs are in terms of anticipatory guidance for symptoms that might be experienced at home and how to navigate those symptoms at home with medication management. You can discuss red flags and signals that may indicate a need for calling a physician,” says Kristin Levoy, PhD, MSN, RN, a Regenstrief Institute research scientist and an assistant professor at Indiana University School of Nursing.
Health systems and hospitals also need to have an infrastructure in place to support care transitions and home caregivers, she says. “Having a common healthcare provider or spokesperson who can advocate for communicating the plan of care to the scope of practitioners who are involved with the patient’s care should incorporate the family caregiver in that process. You also need to coordinate services—make sure that home health shows up, make sure any change in medication is adequately communicated to the primary care provider, and make sure that routine follow-up phone calls are happening in the home to maintain health and prevent hospitalizations.”
Home caregivers can help avoid hospitalizations and hospital readmissions, Levoy says. “To the extent that home caregivers are equipped and engaged in things like anticipatory guidance for symptoms, caregivers can contribute to reducing hospitalizations.”
Active engagement of home caregivers is critical, she says. “What we found was that when home caregivers were actively engaged in the transitional care process—actively receiving education, actively being asked about the needs in the home, and receiving help in care coordination—caregiver engagement with the various components of interventions influenced overall reduction in the probability of hospital readmissions. Those interventions that had caregiver engagement in their intervention design yielded better outcomes. We all anecdotally recognize the contribution that home caregivers are making to patient outcomes, and we have provided some empirical evidence to support that perception.”
Impacts beyond hospitalizations
Home caregiver engagement has positive effects beyond limiting hospitalizations, Levoy says. “Home caregiver engagement broadly helps to ensure a common understanding between the patient, provider, and caregiver about the patient’s condition and their treatment plan. That common understanding helps inform healthcare decision-making. That can be in decisions about selecting treatment options, decisions about self-care in the home, and managing disease with medications. It can also impact decisions about whether to seek emergency care, to go back to the hospital, or to call a provider. All of these things impact patient outcomes.”
Home caregiver engagement also has a positive impact on the caregivers, she says. “Home caregiver engagement not only helps patients—it also helps to improve caregiver outcomes. Other studies have looked at home caregiver engagement and noted improvements in caregiver depression, reduced caregiver burden and distress, and improved quality of life. When we are actively engaging home caregivers as partners in care delivery, we are not only influencing the patient’s outcomes and helping them make better-informed decisions on their own behalf, but also helping caregivers achieve better outcomes for themselves.”
Part of the care team
Home caregivers can play an active role in a patient’s care team, Levoy says. “The home caregiver can serve in a variety of functions. They might be the information broker, where they are soliciting information on the patient’s behalf from the healthcare provider on how to navigate symptoms or deal with issues that come up with the condition between visits. They can advocate for the patient’s preferences when they feel their preferences are not being honored or incorporated into the plan of care.”
Home caregivers can be involved in a patient’s care decision-making, she says. “Oftentimes, patients defer decisions to their caregivers, and they function as the primary healthcare decision-makers for patients. To the extent that they are not tangentially involved in clinical interactions, caregivers are active partners. They can make informed decisions on the patient’s behalf or provide guidance to patients. Home caregivers and patients often move forward together.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.