Study On Relevant Factors Of Readiness For Hospital Discharge And Effect On Unplanned Readmission To The Elderly With Ischemic Stroke

ObjectivesTo investigate the status quo of readiness for hospital discharge to the elderly with ischemic stroke and identify the relevant factors.Then to analyze the relationship about readiness for hospital discharge,adherence to compliance with medical practice and unplanned readmission,as well as to further explore the mediating effect.So as to lay the foundation for putting forward tailored effective recommendations to improve the readiness for hospital discharge of patients and reduce unplanned readmission,which will arouse the medical staff's attention of assessment,increase patients' participation in discharge decisions,and promote the health outcomes.MethodsIt was a cross-sectional survey.Totally 330 the elderly with ischemic stroke,who met the criteria of this study,were conveniently selected from wards of a third-grade hospital in Zhengzhou from November 2017 to July 2018.Questionnaires were issued 4 hours before discharge,including a self-designed general information questionnaire,the Chinese version of the Readiness for Hospital Discharge Scale,Stroke Knowledge and Attitude Questionnaire,Social Support Scale,Self-efficacy for Managing Chronic Disease 6-Item Scale.Inquired adherence to compliance with medical practice and unplanned readmission status by telephone follow-up after 30 days of discharge.Data was logged in Epidata3.1,analyzed by SPSS22.0 and Mplus 7.0.Statistical methods including descriptive analysis,t-test,ANOVA,pearson correlation,Chi-square test,rank sum analysis,multiple stepwise regression,Logistic regression and bootstrap mediation test.The test level was alpha=0.05,and the P value was the two-tailedprobability.Results1.Current descriptionThe mean score of readiness for hospital discharge to the elderly with ischemic stroke was7.68±0.64 points,the average score of personal status subscale was 7.61±1.04 points,coping ability subscale was 8.03±1.02 points,expected support subscale was 7.29±0.88 points.85.8% of the respondents were ready for discharge and 82.7% of them had a good discharge readiness in the coping ability.The average score of knowledge to the elderly with ischemic stroke was 13.99±4.12 points,and the descending rank of each dimension score were risk factors-related knowledge,stroke elementary-related knowledge,recurrence-related knowledge,physical activity-related knowledge.The average score of attitude to the elderly with ischemic stroke was 35.23±4.98 points,and the descending rank of each dimension score were attitude to control of the risk factors,attitude to health responsibility,attitude to insistence on taking exercise.The average score of social support to the elderly with ischemic stroke was 31.06±7.20 points,including the mean score of subjective support was 16.22±4.70 points,objective support was 8.19±2.08 points,and utilization of social support was 6.65±1.92 points.75.0% patients were at moderate level of social support,and only 13.9% of them were at good level.The mean score of self-efficacy to the elderly with ischemic stroke was 6.95±0.98 points;the average score of symptom management dimension was 7.37±1.17 points;the average score of disease common management dimension was 6.58±1.28 points.49.7% of respondents had moderate level of self-efficacy.The adherence to compliance with medical practice to the elderly with ischemic stroke was1.83±0.45 points,and 15.1% of patients had unplanned readmission within 30 days after discharge.2.Multiple stepwise regression analysisThe total score of readiness for hospital discharge as the dependent variable,factors of statistical significance in the single factor as the independent variables,including gender,age,educational degree,marriage condition,monthly income,living pattern,place of residence,admission form,style of onset,family history,complications of ischemic stroke,amount of drug,get medical advice,knowledge and attitude of stroke,social support and self-efficacy,classify the disordered set dummy variables and use stepwise multiple regression method to analyze the data.The multiple logistic regression showed that monthly income,educational degree,knowledge and attitude of stroke,social support,self-efficacy,were the major influential factors(P<0.05),which can explain 41.3% of the total variance.3.The relationship of readiness for hospital discharge,adherence to compliance with medical practice and unplanned readmissionThe readiness for hospital discharge to the elderly patients with ischemic stroke was positively correlated with adherence to compliance with medical practice,r=0.671.The readiness for hospital discharge was negatively correlated with unplanned readmission,r=-0.199.Adherence to compliance with medical practice was negatively correlated with unplanned readmission,r=-0.254.4.Mediation analysisPath coefficient runs as follows: the coefficient of readiness for hospital discharge on adherence to compliance with medical practice was 0.476,the coefficient of readiness for hospital discharge on unplanned readimission was-1.130,and the coefficient of adherence to compliance with medical practice on unplanned readimission was-1.405.The mediating effect accounted for 36.6% of the total effect.Conclusions1.The readiness for hospital discharge to the elderly with ischemic stroke was at a moderate level.Knowledge and attitude of stroke,social support and self-efficacy were all at a medium level.The adherence to compliance with medical practice was slightly lower and unplanned readmission was little higher.2.The major influencing factors of readiness for hospital discharge to the elderly with ischemic stroke included: monthly income,educational degree,knowledge and attitude of stroke,social support and self-efficacy,which were protective factors.3.The readiness for hospital discharge to the elderly with ischemic stroke was favorable factor for adherence to compliance with medical practice.They were both can negatively predict the unplanned readmission.4.The adherence to compliance with medical practice had a mediator effect between readiness for hospital discharge and unplanned readmission to the elderly with ischemic stroke.