Discharge Readiness And Related Factors In Patients With Ischemic Stroke And Multimorbidity:A Mixed-methods Study

Objective:The aim of present study is to investigate the status of discharge readiness of patients in ischemic stroke and multimorbidity by mixed methods research,and explore related factors of the discharge readiness.Based on the results,we are to optimize the discharge readiness,and lay a solid foundation for our research in the field of multimorbidity.Methods:1.Questionnaire survey:We investigated 256 patients in ischemic stroke and multimorbidity who admitted to the Department of Neurology of a Grade 3A hospital in Shenyang between July 2020 and January 2021.The survey tools included general demographic information,Readiness for Hospital Discharge Scale(RHDS)and Discharge Teaching Scale(QDTS).2.Descriptive interviews:10 caregivers of patients in ischemic stroke and multimorbidity who met the inclusion criteria were selected for one-to-one semi-structured interviews.3.The data obtained from the quantitative study were mainly analyzed by SPSS 24.0 software.The main analytical methods included descriptive analysis,spearman rank correlation analysis,univariate analysis and multiple linear regression analysis.After the data of qualitative research was transcribed into text data,content analysis method was used to analyze the transcribed text.Results:The results of quantitative study show:1.The total score of discharge readiness is 83.05±13.78,and the average score for all the items is 6.92±1.15.The score of three subscales are personal status dimension 21.10±4.93,coping ability dimension 33.47±8.35 and expected support dimension 28.48±3.79 in patients with ischemic stroke and multimorbidity,and the average score for all the items in three subscales are 7.03±1.64、6.69±1.67、7.12±0.95;2.The total score of discharge teaching is 184(179,190),which is moderate level,and the score of three subscales are personal status dimension 51(47,54),coping ability dimension 40(36,43)and expected support dimension 94(90,99)in patients with ischemic stroke and multimorbidity;3.The results of the correlation analysis show that the scores of discharge teaching quality are positively correlated with the scores of discharge readiness(r=0.102,P<0.05).Except for the Content Needed dimension,the scores of the Content Received and the scores of Delivery of Discharge Teaching dimension are positively correlated with discharge readiness score.4.Univariate analysis show that age and numbers of comorbidity are related factors of discharge readiness(P<0.05);5.The results of multiple linear regression analysis show that the numbers of comorbidity,educational level and delivery of discharge teaching,have strong significance on patients’discharge readiness(adjusted R~2=0.121,F=6.835,P<0.001).The results of qualitative research showed:1.Although the patients’personal status did not reach the ideal state,they were generally satisfied;2.The patients’coping ability was insufficient,such as inadequate disease-related knowledge,poor self-care ability,bad compliance behavior and poor emotional management ability;3.The patients’expected support was insufficient,such as insufficient family support,poor community health care and lack of continuing of care services.Conclusion:The RHDS scores among patients in ischemic stroke and multimorbidity is low,which is mainly due to inadequate disease-related knowledge,poor self-care ability,bad compliance behavior,poor emotional management ability,insufficient family support poor community health care and lack of continuing of care services;The numbers of comorbidity,educational level and delivery of discharge teaching are signficant related factors of discharge readiness.