Research On Assessment Criteria For Medical Patient Admitting And Discharging Of The Rehabilitation Nursing Bed

In order to optimize the health care resource allocation, to promote vertical integration of regional health care resources, to improve service efficiency, and to alleviate the situation of"difficult hospitalized and high fee" in Shanghai, Shanghai Medical affairs working meeting put forward the"Bed Classification Managemen"t measures in 2006. According to"Shanghai Health Development Eleventh Five-Year Plan", all of the beds in the city with various service functions are divided into therapeutic bed, rehabilitation nursing bed and other bed in the medical institutions. This classification will guide the rational triage of patients and protect the people's basic health rights, and at last, promote the development of harmonious society.In this research, from the referral joint of therapeutic bed to rehabilitation nursing bed, according to bed function of the latter, we set up an"Assessment Criteria Model for Medical Patient Admitting and Discharging of the Rehabilitation Nursing Bed", which used literature review, theoretical research, cross-sectional study, qualitative interviews, Delphi method and so on. The assessment criteria include three parts: assessment criteria principles of medical patient admitting and discharging of rehabilitation nursing bed; suitable medical diseases for occupation rehabilitation nursing Bed; and the corresponding assessment criteria of each diseases. On this basis, we collect a small number of single-disease medical patients who admitted and non-stay to the rehabilitation nursing bed to finish a comparative study, as well as an analysis on influnce factors of medical patients wishes to the rehabilitation nursing Bed.This research is divided into eight parts.Part I: Study overview. To introduce a research background; to define the relevant concepts such as"standard"; to expatiate the related health services status quo at home and abroad; to explain the theoretical basis of the research and dimensions and principles of the assessment criteria; to describe the main research methods and technical route. Part II: Research work before the expert consultation and the formation of expert advice sheet. Using purposive sampling method to select 8 medical institutions which containing rehabilitation nursing Bed in Shanghai to investigate the current situation and to evaluate their service; simultaneously to conduct qualitative interviews in that 8 institutions to master experts advices for our research. In medical institutions which including therapeutic bed, we select some experts to conduct qualitative interviews in order to collect the principles of referral criterion and made them to screen suitable medical diseases for the bed. After screening 46 suitable medical diseases for the bed, we standardize their names with ICD-10. The expert advice sheet was established on this basis and we select 120 experts in Shanghai to take part in the expert consultation.Part III: Two rounds of expert consultation and statistical analysis of the results. After two rounds of expert consultation and statistical analysis of the results, we determine 7 admitted and 5 transferred principle items of the medical patients to rehabilitation nursing Bed. From 8 specialist department such as rheumatoid immune section, we screen 46 suitable medical diseases for occupation rehabilitation nursing Beds, and also confirmed 46 diseases'specific assessment criteria.Part IV: Construction of"Assessment Criteria Model for Medical Patient Admitting and Discharging of the Rehabilitation Nursing Bed". In the expert meeting, we use the expert score method to determine 7 admitted and 5 transferred principle items weight and the number of the medical patients to rehabilitation nursing Bed, the suitable medical diseases for the bed and diseases'specific assessment criteria.Part V: Case study of stroke (infarction) patients in the rehabilitation nursing Bed. Choosing 9 stroke (infarction) patients in therapeutic bed as research subjects, dividing them into two groups which is be or not to rehabilitation nursing Bed when they meet the admission standards, comparing two sets of patients data, the results show that the occupancy group patients'total cost and average cost of medicine lower than those of non-admitted, ADL score beforedischarging from hospital high than the latter, the number of hospitalized days longer than the latter. Part VI: Influence factors analysis of medical patients admitting rehabilitation nursing Bed. Choosing 37 patients in 8 medical wards with a questionnaire survey, in accordance with their wishes will be or not to rehabilitation nursing Bed they were divided into two groups. Logistic regression analysis shows that the medical patients to the bed or not were determined by three main factors: patients ages, the extent of disease at admission and economic condition of the payer.Part VII: Discussion. To analyze and discuss the research process and give advices as following:①to strengthen the vertical integration of health resources, emphasis on the role of primary health care;②to improve rehabilitative and nursing bed service level, increase patient confidence ;③to pay attention to general practitioners and community nurses cultivation;④to make the medical insurance playing a role of supervision and standardize the referral service;⑤to guide rational patient triage by propagandizing the community health service.Part VIII: Conclusion. Summing up of the full text, pointing out the lack of this research, innovation and research direction in the future study.