Caroline Carlin1,2, Guy David3. 1. Medica Research Institute, Minneapolis, MN. 2. Department of Family Medicine and Community Health, University of Minnesota, Minneapolis. 3. Health Care Management Department, Wharton School, University of Pennsylvania, PA.
Abstract
CONTEXT: Prior literature has focused on the impact of informal caregiving (presence of a family member in the home or nearby) on caregiver employment, but little research has analyzed the impact of informal caregiving on health care utilization patterns. OBJECTIVE: To study the effect of informal caregivers on postacute care and recovery of Medicare patients. DESIGN: We used cross-sectional Health Plan administrative data to measure differences in health care utilization for Medicare patients who did and did not have coresident adult caregivers available. We identified coresident caregivers as those residing at the same postal address as discharged patients. Analysis was a combination of Poisson and logit models. MAIN OUTCOME MEASURES: Length of hospitalization, type of hospitalization (ambulatory-care sensitive vs not), likelihood of discharge to postacute care (skilled nursing facility or home health), and likelihood of hospital readmission and postdischarge Emergency Department visits. RESULTS: Patients with caregivers were discharged after shorter hospital lengths of stay and were less likely to require postacute emergency care, home health services, or discharge to skilled nursing facilities. Savings were smaller when caregivers were younger, in poor health, or female. We extrapolated the reduced utilization associated with a coresidential caregiver to estimate Medicare savings of $514 million in 2015. CONCLUSION: By calculating the impact of informal caregiving on patterns of health care utilization, we support the need to integrate the availability of caregivers into discharge planning. Future quantification of differences by caregiver characteristics is important.
CONTEXT: Prior literature has focused on the impact of informal caregiving (presence of a family member in the home or nearby) on caregiver employment, but little research has analyzed the impact of informal caregiving on health care utilization patterns. OBJECTIVE: To study the effect of informal caregivers on postacute care and recovery of Medicare patients. DESIGN: We used cross-sectional Health Plan administrative data to measure differences in health care utilization for Medicare patients who did and did not have coresident adult caregivers available. We identified coresident caregivers as those residing at the same postal address as discharged patients. Analysis was a combination of Poisson and logit models. MAIN OUTCOME MEASURES: Length of hospitalization, type of hospitalization (ambulatory-care sensitive vs not), likelihood of discharge to postacute care (skilled nursing facility or home health), and likelihood of hospital readmission and postdischarge Emergency Department visits. RESULTS:Patients with caregivers were discharged after shorter hospital lengths of stay and were less likely to require postacute emergency care, home health services, or discharge to skilled nursing facilities. Savings were smaller when caregivers were younger, in poor health, or female. We extrapolated the reduced utilization associated with a coresidential caregiver to estimate Medicare savings of $514 million in 2015. CONCLUSION: By calculating the impact of informal caregiving on patterns of health care utilization, we support the need to integrate the availability of caregivers into discharge planning. Future quantification of differences by caregiver characteristics is important.
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