Research On Current Situation Of Transitional Care And The Needs Of Discharged Patients

Objective: In this study, a questionnaire survey was implemented among hospitals, discharged patients and clinical nurses to investigate the current situation, patients' needs and nurses' cognition of transitional care, and analyze the problems and challenges faced by hospitals. The purpose was to provide data for exploring a transitio nal care mode which can meet Chinese patients' demands and for medical organizations to formulate policies about transitional care.Methods: 1. Literature review. Plenty of relevant literatures and Chinese health service investigation and research reports were reviewed to determine the research directions and contents of ths study, and then preliminarily design the main dimensions and items of questionnaires. 2. Delphi expert concensus. Eleven nursing experts were invited to separately evaluate the importance of the items and contents of the questionnaires. After two rounds of expert concensus, the final three questionnaires in this study were formed. 3. Questionnaire survey. Cross-sectional study method was adopted in this study. A total of 1287 discharged patients in a comprehensive tertiary hospital selected by convenient sampling were surveyed to screen typical diseases which had strongest needs of transitional care. A total of 44 nursing managers, 2209 discharged patients and 1941 clinical nurses from 46 secondary and tertiary comprehensive hospitals in 12 provinces selected by convenient sampling were surveyed by three kinds of questionnaires ?Transitional Care Questionnaire of Current Situation?, ?Transitional Care Questionnaire of Patient Needs? and ?Transitional Care Questionnaire of Nurse Cognition?. 4. Statistical analysis. Data was entered via Microsoft O ffice Excel, and analyzed by SPSS17.0 software. Mean, standard deviation, median and composition ratio were adopted in descriptive statistical analysis; c2 test, Mann-Whitney U test and Kruskal-Wallis H test were adopted in hypothesis test; unconditioned logistic regression analysis was adopted in multi-factor analysis.Results: 1. The top ten diseases of transitional care needs were hypertension, leukemia, coronary heart disease, chronic renal insufficiency, breast tumor, intracranial tumor, uterus tumor, ful-term pregnancy, childhood leukemia and premature babies. 2. Among 44 hospitals' effective data, 43 hospitals(97.7%) had implemented trans itional care. In the 43 hospitals, 11 hospitals(25.6%) were organized by specialized departments, 15 hospitals(34.9%) charged reasonable fees, and 23 hospitals(53.5%) evaluated the outcomes after transitional care. The most widely covered contents of transitional care were medication instruction(100.0%), diet instruction(100.0%) lifestyle instruction(95.3%) and disease knowledge education(95.3%). The most widely covered methods were discharge education(100.0%), telephone/message follow-up(100.0%) and health knowledge lectures(95.3%). Main caregivers were primary nurses(90.7%) and clinical nurse specialists(76.7%). The main obstacles during transitional care were human resource shortage, undefined service procedure, imperfect hospital-community transfer system and lack of national policies. 3. The most needed transitional care contents by discharged patients were medication instruction(91.6%), diet instruction(88.0%) and subsequent visit reminder(85.3%). The most preferred methods were discharge education(79.2%), telephone/message follow-up(78.0%) and health knowledge lectures(72.7%). Patients' favorite caregivers were doctors(67.8%), followed by nurses(41.2%). Among all the discharged patients, 76.2% were wil ing to pay for transitional care service. 4. Discharged patients' needs of transitional care were affected by factors such as gender, age, educational level, marital status, work status, family income, disease diagnosis, surgery, self-care ability and caregiver. 5. In clinical nurses' opinion, the most needed transitional care contents by discharged patients were medication instruction(98.4%), diet instruction(97.6%), disease related knowledge instruction(97.5%) and subsequent visit reminder(96.2%). The most needed methods were discharge education(97.8%), health knowledge lectures(94.7%), and telephone/message follow- up(93.1%). The most needed caregivers were community nurses(56.3%) and community doctors(55.0%). More than 90% of the clinical nurses agreed the meaning of transitio nal care, 64.0% agreed nurses' responsibility in transional care, 85.2% thought that transitional care increased the burden of nurses, and 82.2% thought that a professional team should be responsible for the organization and implementation of transitional care. The main obstacles to nurses during transitional care were human resource shortage, insufficient cognition by patients, lack of laws and regulations, and undefined charging standards.Conclusion: 1. Under the background of discharge patients ' high demands, transition care had been preliminary started in C hina. It had basically covered high demanded diseases, and the contents and methods of transitional care were diversified. 2. Individualized transitional care protocol should be put forward according to patients' needs and diseases. 3. Standard transitional care procedures should be formulated to endure the quality and effect of transitional care.4. A post of transional care and multidisciplinary team should be set up, high- level, specialized transitional nurse should be cultivated to improve the service level of transitional care. 5. Informatization system and hospital-community transfer system construction should be accelerated to ensure community medical institutions' role in long-term care. 6. Relevant laws, regulations, charging standards and health policies should be formulated to promote the management, implementation and development of transitional care.