Establishment And Application Research Of Disease Management Pathway In Patients With Ischemic Stroke

Objective: The clinical pathway of disease management for patients with ischemic stroke was established,and its practicability and reliability were verified through clinical practice.Methods: The study was conducted in two phases: 1 Defining the structural framework of the disease management pathway,summarizing the best evidence by referring to the guidelines,and formulating the clinical pathway for the disease management of patients with ischemic stroke;2 the experiment was conducted by non-randomized controlled study.The 112 patients who met the criteria and signed the informed consent were divided into two groups by convenience sampling,each with 56 patients.From January to May 2019,the patients were the control group,and carried out the work according to the routine nursing of ischemic stroke;In the intervention group from June to October of the same year,diagnosis and treatment and nursing were carried out through the clinical pathway of disease management.On the premise that the baseline data of the two groups were comparable,by the national institutes of health stroke scale(NIHSS)scores,Barthel index(BI)questionnaire,self-efficacy scale for chronic diseases,health education knowledge questionnaire,patient satisfaction questionnaire to compare the improvement of nerve function defect degree,daily life activities ability,self-efficacy,disease knowledge and satisfaction degree in two groups,to evaluate the effect of the disease management path.Results: 1 The best evidence related to disease management,including 24 pieces of evidence in 5 categories,was extracted by searching the guidelines for ischemic stroke.There are 19 recommendation items of grade A and 5 recommendation items of grade B;2 Based on the two rounds of preliminary tests,expert consultation and group discussion,a disease management pathway for ischemic stroke and a nursing guidance program for early rehabilitation of ischemic stroke were developed;3 Baseline data: there was no statistically significant difference between the two groups in age,gender,education level and other demographic data and disease degree(P > 0.05),and the baseline was comparable;4 The results of the intervention of the disease management pathway showed: 1)comparing the degree of neurological dysfunction at discharge,NIHSS score of the intervention group was lower than that of the control group,and the difference was statistically significant(P < 0.05);2)the BI scores of the intervention group at discharge,1,3 and 6 months after discharge were higher than those of the control group,with statistically significant differences(P < 0.05);3)the self-efficacy scores of the intervention group at discharge time,1,3 and 6 months after discharge were higher than those of the control group,with statistically significant differences(P < 0.05);4)the scores of health education knowledge at the time of discharge,1,3 and 6 months after discharge in the intervention group were higher than those in the control group,with statistically significant differences(P < 0.05);5)when comparing the two groups of patients' satisfaction at discharge,the intervention group was higher than the control group,and the difference was statistically significant(P < 0.05).Conclusion: The pathway-based disease management improves patients' limb function and their daily activities,enhances their confidence in overcoming the disease,and improves their satisfaction.The application in clinical work has feasibility and safety.