The Study Of Development And Application On Discharge Planning Progam For Patients With Chronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease (COPD) is one of the ten common causes of death in the world and has become an important public health problem. COPD patients have to revisit hospitals frequently due to the acute exacerbation after being discharged from hospital, which results in heavy medical and economic burdens for society and individual. Literature shows that providing continuous care can help patients to improve their self-management abilities. Discharge planning plays a critical role in a successful continuous care. However, such discharge planning in the management of COPD patients is still in a very early stage in China.Objective:The present study aims to establish a hospital-based discharge planning program for patients with COPD in China, in which the provision of a systematic and feasible continuous care was focused and its clinical effectiveness evaluated.Methods:Based on the comprehensive analysis of international discharge planning guidelines and COPD management and COPD care guidelines, this study used the action research method, including qualitative and quantitative study, and semi-structure interviews with COPD patients to establish a draft of COPD discharge planning program. Then the established draft plan was revised and improved after the focus group interview with a group of multidisciplinary team and the preliminary experiment. A quasi-experimental design was used in this study. A total of83COPD patients recruited from the hospital were randomly divided into the discharge planning group (n=42) and the control group (n=41). The control group received routine care. While the discharge planning group received in addition the discharge planning services on the third day since admitted. The outcome measures include COPD Self-management, SF-36, CAT, ADL, BMI, and MMRC, Length of Stay, Hospitalization Costs, Readmission Rate and Patients' Satisfaction.Results:The full data collection was completed from totally73patients, including the discharge planning group (n=38) and the control group (n=35). The results showed that the level of self-management of patients with discharge planning group was improved significantly (P<0.01), quality of life was improved (physical functioning P=0.027, social function P=0.016, role emotional P>0.05, the other dimensions P<0.01), and the CAT score was decreased significantly (P<0.01), patients' satisfaction was significantly enhanced (P<0.01). However, there was no significant difference between two groups in ADL, BMI, MMRC, length of stay, hospitalization costs and readmission rate (P>0.05).Conclusion:The present study shows that a COPD discharge program increased the level of self-management for COPD patients and improved their quality of life. We; therefore, conclude that an effective planning program can be helpful to COPD patients in achieving a smooth transition from a hospital environment to a home care environment.