| PurposeThe aim of this study was to construct discharge readiness intervention scheme for elderly patients with chronic heart failure based on transition theory and discharge readiness model,and to evaluate the clinical application effect of this plan.methodsThis study was divided into two parts:1.Intervention scheme construction(1)Literature review: The databases were searched for literature related to discharge preparation of chronic heart failure patients both domestically and internationally from January 2012 to January 2022,and the best evidence was extracted and summarized.Based on transition theory and combined with discharge preparation models,an evidence-based intervention plan for elderly chronic heart failure patients was developed.(2)Group discussion: The research group of the project adopted the form of a round table group meeting,used brainstorming method,and combined evidence-based basis to discuss the theme,time,frequency,form,content,personnel,and other aspects of the intervention plan,and constructed the first draft of the discharge readiness intervention plan for elderly patients with chronic heart failure.(3)Expert letter consultation: 15 experts in related fields were invited to conduct two rounds of expert consultation and revise the draft intervention scheme for discharge readiness of elderly patients with chronic heart failure according to their opinions.(4)Pre-experiment: 10 elderly patients with chronic heart failure who met the standard of sodium exclusion were selected for pre-experiment,and the intervention scheme was improved according to the results of the pre-experiment,and finally the discharge readiness intervention scheme for elderly patients with chronic heart failure was formed.2.Intervention program implementation and effect evaluationUsing convenience sampling method,92 elderly patients with chronic heart failure who met the inclusion and exclusion criteria who admitted to the cardiology department of a tertiary hospital in Qingdao from September to December 2022 were selected as the study subjects.Using the coin toss method,patients were randomly divided into two groups,patients in the first cardiac ward as the intervention group(46 cases)and the second cardiac ward as the control group(46 cases).The control group received traditional heart failure care and discharge guidance,while the intervention group received discharge readiness intervention based on traditional care.The data analysis was conducted using Jamovi 2.3.24 and SPSS 26.0 software,including a series of statistical descriptions,chi square tests,Fisher’s exact tests,Shapiro Wilk tests,independent sample t-tests,Mann Whitney U tests,repeated measurement variance analysis,generalized estimation equations,etc.The intervention group and control group were compared before and after intervention in terms of discharge readiness,self-care ability,discharge guidance quality,quality of life,6-minute walking test,unplanned admission rate,etc.to evaluate the application effect of the intervention scheme.Results1.Result of intervention scheme construction: The specific themes of the intervention scheme construction included six primary items: "Intelligent Life,I Participate","Heart Failure Management,I Can Do It","Self care,I Can Do It","Easy Life,I Have Fun","Happy Discharge,Confidence in Going Home",and "Safety and Health Accompanying Me";The first draft of 17 second items,after two rounds of correspondence,showed a 100% positivity rate among experts;The expert authority coefficient Cr values were all 0.82;The importance and feasibility of the primary and second items in the first round of expert coordination coefficient(Kendall’s W)were0.235,0.133,and 0.177,0.126,respectively(P<0.05);The importance and feasibility of the primary and second items in the second round were 0.354,0.225,and 0.223,0.355respectively(P<0.05),with coefficients of variation<0.25.The scheme was adjusted based on the patient feedback in the pre-experiment,and the final intervention scheme was ultimately constructed.The intervention scheme relied on the information technology,including intelligent assistants(such as Xiaoai and Xiaodu)and We Chat mini programs(such as Kyushu Youhu),integrated education tools,and the intervention team carried out the specific clinical implementation process.2.Intervention scheme implementation and effect evaluationDuring the intervention process,there were 2 cases lost in the intervention group(4.3%)and 3 cases lost in the control group(6.5%).The total number of cases that completed this study was 87,with an effective sample size of 44 cases in the intervention group and 43 cases in the control group.(1)Discharge readiness: The intervention group was significantly higher than the control group(P<0.05).(2)Quality of discharge guidance: The intervention group was significantly higher than the control group(P<0.05).(3)Self-management ability: The total scores of self-management in the intervention group gradually decreased before discharge,1 month and 3 months after intervention(P<0.05);There was no statistically significant difference in the total scores of the control group before discharge,1 month,and 3 months after intervention(P=0.089).After 1month and 3 months of intervention,the total self-management scores of patients in the intervention group were significantly lower than those in the control group(P<0.05).(4)Quality of life: There was a statistically significant difference in the total scores of quality of life before discharge,1 month,and 3 months after intervention in the intervention group(P<0.001),while there was no statistically significant difference at different time points within the control group(P=0.569).There was no statistically significant difference in the total scores between the two groups before discharge(P=0.599).One month after the intervention,there was still no statistically significant difference between the two groups(P=0.468).Three months after the intervention,the total score of the quality of life in the intervention group were significantly lower than that in the control group(P<0.05).(5)6-minute walking test: There was a statistically significant difference in the6-minute walking distance before discharge,1 month,and 3 months after intervention in the intervention group(P<0.05),while there was no statistically significant difference at different time points within the control group(P=0.117).After 1 month and 3 months of intervention,the 6-minute walking test results of patients in the intervention group were significantly higher than those in the control group(P<0.01).(6)Unplanned readmission rate: The incidence of unplanned readmission at 1 month and 3 months after intervention was compared between the two groups.The incidence of unplanned readmission at 1 month and 3 months in the intervention group was 11.4% and6.8%,respectively,which were significantly lower than that of 37.2% and 32.6% in the control group(P=0.005,0.002).ConclusionThe discharge readiness intervention scheme for elderly patients with chronic heart failure based on transition theory and discharge readiness model constructed by this study has unanimous expert opinions and is scientific and feasible.The intervention plan can improve the patient’s discharge readiness,quality of discharge guidance,and self-management ability,ultimately improving the quality of life and cardiac function level,and effectively reducing the unplanned readmission rate. |
PDF Full Text Request