JMIR Publications

ABSTRACT

Background:

The Caregiver Advise Record Enable Act (CARE Act) is a state level law that requires hospitals to identify and educate caregivers (‘family members or friends’) upon discharge.

Objective:

This study examined the association between the implementation of the CARE Act in a Pennsylvania health system and health service utilization (i.e., reducing hospital readmission, emergency department (ED) visits, and mortality) for older adults with diabetes.

Methods:

Key elements of the CARE Act were implemented and applied to patients discharged to home. The data were pulled between May 2017 and October 2017 from inpatient electronic health records (EHR). Likelihood-ratio chi-square tests and multi-variate logistic regression models were used for statistical analysis.

Results:

The sample consisted of 2,591 older inpatients with diabetes with a mean age of 74.6±7.1 years, female (46.5%), White (86.9%), type 2 diabetes (97.4%). Of these, 1,801 (69.5%) identified a caregiver; among the caregivers identified, 399 (22.2%) received discharge education and training. We compared the differences in health service utilization between pre-post implementation of CARE Act; however, no significance was found. No significant differences were detected from bi-variate analyses in any outcomes between individuals who identified a caregiver and those who declined to identify a caregiver. After adjusting for risk factors (multi-variate analysis), identification of a caregiver was associated with higher rates of 30-day hospital readmission compared with declining to identify a caregiver (12.2% vs. 9.9%, odds ratio (OR) 1.38, 95%CI:[1.04,1.87]; p=.025). Significantly lower rates were detected in 7-day readmissions (p =.018), as well as 7-day (p =.026) and 30-day (p =.013) ED utilization, among diabetes patients whose identified caregiver received education and training compared with those whose identified caregiver did not receive education and training in the bi-variate analyses. However, after adjusting for risk factors, no significance was found in the 7-day readmissions (OR [95%CI]: 0.53 [0.27, 1.05]; P =.070), 7-day ED utilization (OR [95%CI]: 0.63 [0.38, 1.03]; P =.068) and 30-day ED utilization (OR[ 95%CI]: 0.73 [0.52, 1.02]; P =.066). No significant associations were found for other outcomes (i.e., 30-day readmissions and 7-day and 30-day mortality) in both bi-variate and multi-variate analysis.

Conclusions:

Our study found that implementation of the CARE Act was associated with certain health service utilization. Identification of caregivers was associated with higher 30-day hospital readmissions in the multi-variate analysis. While, when the identification of caregivers who received education was association with lower rates of readmission and ER Utilization in the bi-variate analysis.