Rayan-Gharra Nosaiba, Tonkikh Orly, Gur-Yaish Nurit
The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Oranim Academic College of Education, Tivon, Israel.
PLoS One. 2025 Jul 17;20(7):e0327758. doi: 10.1371/journal.pone.0327758. eCollection 2025.
Family members or friends (caregivers) play a substantial role in supporting health needs of older adults or persons with chronic conditions and accompanying them in acute-care settings. Scarce evidence on the impacts of caregiver engagement in ensuring and explaining medical care during hospitalization calls for further exploration of the role of caregivers along the peri-hospitalization trajectory in supporting hospitalization outcomes. This study aimed to examine the association between pre-admission caregiver support and care recipients' preparedness for discharge and whether caregiver engagement during hospitalization and upon discharge mediates this association.
Secondary analysis of a cohort study of 443 internal medicine patients who were accompanied by caregivers. Pre-admission caregiver support, engagement in ensuring and explaining medical care during hospitalization, and covariates like health literacy, demographics and health status were reported by patients during hospitalization. Caregiver involvement in the discharge briefing and care-transition preparedness was reported a week after discharge.
Multivariate mediation analysis showed significant direct effect (B(unstandardized)=1.55; CI = 0.09-2.99; P = 0.036) of pre-admission caregiver support on care-transition preparedness. The effect was mediated by high caregiver engagement in ensuring and explaining medical care during current hospitalization (Mediated effect (ME)=2.84; CI = 1.78-4.00) and involvement in the discharge briefing (ME = 0.71; CI = 0.20-1.29), controlling for patient and caregiver health and functional status, health literacy, and demographics (Total effect: B(unstandardized)=5.10; CI = 3.21 to 7.01). Of the covariates, only high health literacy levels of the patients (B(unstandardized)=4.56; P < .001) and of the caregivers (B(unstandardized)=6.67; P < .001) were positively associated with preparedness for discharge.
This study highlights the critical role of caregiver engagement during the hospitalization process as a pathway linking pre-admission support to discharge preparedness. The findings support early identification of caregiving status and health literacy at admission, enabling healthcare providers to tailor communication and better engage caregivers in the discharge process, to ultimately promote smooth care transitions.
家庭成员或朋友（照顾者）在满足老年人或慢性病患者的健康需求以及在急症护理环境中陪伴他们方面发挥着重要作用。关于照顾者参与确保和解释住院期间医疗护理的影响的证据稀少，这需要进一步探讨照顾者在围住院期轨迹中对支持住院结局所起的作用。本研究旨在检验入院前照顾者支持与受照顾者出院准备情况之间的关联，以及住院期间和出院时照顾者的参与是否介导了这种关联。
对一项队列研究进行二次分析，该研究纳入了443名有照顾者陪伴的内科患者。患者在住院期间报告了入院前照顾者的支持、在确保和解释住院期间医疗护理方面的参与情况，以及诸如健康素养、人口统计学特征和健康状况等协变量。在出院一周后报告照顾者参与出院简报和护理过渡准备情况。
多变量中介分析显示，入院前照顾者支持对护理过渡准备情况有显著的直接效应（B（非标准化）=1.55；CI = 0.09 - 2.99；P = 0.036）。在控制患者和照顾者的健康及功能状况、健康素养和人口统计学特征后，这种效应通过照顾者在当前住院期间高度参与确保和解释医疗护理（中介效应（ME）=2.84；CI = 1.78 - 4.00）以及参与出院简报（ME = 0.71；CI = 0.20 - 1.29）来介导（总效应：B（非标准化）=5.10；CI = 3.21至7.01）。在这些协变量中，只有患者（B（非标准化）=4.56；P <.001）和照顾者（B（非标准化）=6.67；P <.001）的高健康素养水平与出院准备情况呈正相关。
本研究强调了照顾者在住院过程中的参与作为将入院前支持与出院准备联系起来的途径的关键作用。研究结果支持在入院时尽早识别照顾情况和健康素养，使医疗保健提供者能够调整沟通方式，更好地让照顾者参与出院过程，最终促进顺利的护理过渡。
