Impact Evaluation To The Application Of Discharge Planning Model In Patients With Chronic Obstructive Pulmonary Disease

Objectives:1.Develop discharge planning model (DPM) to link hospital-based nursing care and community-based nursing care.2.Explore impact of DPM to length and medical costs of hospitalization, frequency of disease exacerbation and readmission among patients with chronic obstructive pulmonary disease (COPD).3.Observe impact of DPM to self-efficacy, quality of life, cognition of self-care among patients with COPD.Methods:The study recruited 100 patients who were admitted to Department of Respiratory Medicine of two general hospitals due to acute exacerbation of COPD. One hospital was the affiliated hospital of a medical university and another was a city-level hospital of Integrated Traditional Chinese Medicine and Western Medicine. These patients were randomized to study group (50 cases) and control group (50 cases). DPM was implemented in study group. Study objects were provided with concrete information of subsequent care during their hospitalization, including health education on relevant disease which was initiated 48 hours after admission; assessment of patient's needs on discharge; establishing file for discharge planning; distribution of nursing guidebook of COPD; follow-up through phone calls every two week after discharge; follow-up visits to continue the implementation on 1 month, 3 month, 6 month post-discharge respectively. Normal nursing care was provided to the control group. Data collection for both groups included evaluation indicators at admission, discharge, 1 month, 3 month, and 6 month, such as days of hospitalization, medical costs, cognitive score of self-care, self-efficacy score, quality of life score, and frequency of acute recurrence and of readmission. Data collected were statistically analyzed with t test, chi-square test, and repetitive analysis of variance to explore the impact of DPM.Results:1.There was no statistical significance (P>0.05) in length of hospitalization and medical costs between two groups.2.There was statistical significance (P<0.05) in frequency of disease exacerbation and readmission within half year's intervention between two groups.3.No statistical significance indicated (P>0.05) in cognitive score of self-care prior to the intervention between two groups. But there was statistical significance in cognitive score of self-care after the intervention between two groups. Cognitive score of self-care of the study group was significantly higher than that of the control group.4.Overall score of self-efficacy and self-efficacy score such as of emotional fluctuation, physical activity and environment was higher (P<0.01) in the study group than that in the control group after intervention. There was no statistical significance(P>0.05) in management of dyspnea and security behavior. 5.Score of quality of life in physical and emotional function, satisfaction of nursing care, was significantly higher in the study group than that in the control group (P<0.05). However, there was no statistical significance in score of coping skills (P>0.05).Conclusion:1.Cognitive capacity of COPD patient has been significantly improved after DPM nursing care implemented compare to normal nursing model.2.DPM was not able to reduce length and costs of hospitalization but it reduced frequency of disease exacerbation and readmission, as well as alleviated symptoms and prolonged disease recurrence.3.DPM could increase self-efficacy of COPD patients so as to improve their psychological and social function and quality of life.