Construction Of Case Management And Care Framework For Inpatient Stroke Patients

purposeThe purpose of this study is to construct a scientific and practical framework of case management care for inpatients with stroke,and to provide a reference for clinical medical staff to implement case management practice of stroke.method1.A large number of domestic and foreign literatures were retrieved through literature review,literature screening and reading were screened,summarized,and relevant information was extracted,so as to provide a theoretical basis for clarifying the contents of case management of hospitalized stroke patients.2.Phenomenological research method was adopted to discuss the role and responsibilities of stroke case managers through face-to-face interviews,so as to provide objective basis for the construction of case management and care framework for hospitalized stroke patients.3.The Delphi expert letter consultation method was used to consult and collect expert opinions for many times,and a practical framework of case management and care for inpatient stroke patients was constructed that could guide clinical medical staff to implement.results1.Literature review was used to complete the background research,and based on the latest case management practice standard issued by the American Case Management Association in 2016 and the role and responsibilities of case managers issued by the American Case Management Professional Accreditation Committee in 2019,the framework of case management care for hospitalized stroke patients was constructed.2.Through face-to-face semi-structured interviews,sum up the stroke case management division of the six roles and corresponding duties Including: First is a needs assessor and comprehensive evaluation,(1)to assess disease-related risk factors in stroke patients(2)to assess the health education needs of stroke patients(3)to evaluate the anxiety and depression mood of stroke patients(4)to assess the support needs and care capacity of stroke caregivers.Second,plan coordinators and resources coordinate and make plans,(1)Coordinate the case management team in planning(2)coordinate multidisciplinary diagnosis and treatment(3)assist patient referrals.Third,education consultants and timely targeted health education,(1)disease cognition,treatment and early symptom recognition(2)risk factors in convalescence self-management education(3)rehabilitation training and other related knowledge of health education.Fourth is the supervision of feedback and feedback and post-discharge management(1)feedback implementation results(2)management and supervision after discharge.Fifth,evaluator and outcome evaluation(1)evaluation of the effectiveness of the case management plan(2)analysis evaluation of patient-related outcome data;Sixth,researchers and scientific research.3.Through 2 rounds of Delphi expert letter consultation,the framework of case management and care for inpatients with stroke was finally determined,including 3first-level indicators,8 second-level indicators and 35 third-level indicators;The evaluation indexes of stroke patient case management effectiveness included 2 first-level indicators,3 second-level indicators and 23 third-level indicators.Nineteen experts were included in the study.(1)The authority coefficients of the experts were 0.91 and 0.93,respectively,with both > 0.7,indicating good expert authority.(2)The recovery rate of the two rounds of questionnaires was 90.91% and 100%.No blank items or missing items were returned on time,indicating that experts had high enthusiasm and attention.(3)The coefficient of variation of each index is between 0.00 and 0.30,and the coefficient of variation of most indexes is less than 0.15,indicating that opinions are relatively concentrated.(4)The Kendall’s concordant coefficient of stroke work framework content and effectiveness evaluation index in the first round of expert consultation were 0.29 and0.30,respectively;In the second round of expert consultation,the Kendall concordant coefficient of stroke work framework content and effectiveness evaluation index were0.32 and 0.34,respectively,and the significance test was statistically significant(P <0.01).The consistency of expert opinions was good.conclusionsIn the process of constructing the case management care framework for hospitalized stroke patients,the expert authority was relatively good and the enthusiasm was relatively high,and the expert opinions on the importance evaluation of each item were highly concentrated,which could provide reference for clinical medical personnel to carry out stroke case management work in the future.