| Objective To construct an intervention program of discharge preparation service for elderly COPD patients based on focused solution approach,and to evaluate the impact of the intervention program on discharge preparation,discharge guidance quality,self-management ability,disease uncertainty level,unplanned readmission,readmission interval,length of stay and hospitalization cost of elderly COPD patients.According to the results of the study,this study provides reference for further improving the level of discharge preparation in elderly COPD patients and developing more perfect discharge preparation services.Methods1.We develop a draft of discharge preparation services for elderly COPD patients based on a focused solution approach through retrieving and understanding the hospital preparation services at home and abroad literatures,combining with the problems in the implementation of discharge preparation service for elderly patients with chronic diseases,and consulting the respiratory health care experts.Then through the pilot investigation,the existing problems were found,sorted out and modified,and finally we form the final draft of the discharge preparation service intervention program for elderly COPD patients based on the focused solution approach.2.From March 2021 to October 2021,74 elderly COPD patients who met the inclusion and exclusion criteria in respiratory department of a third class A hospital in Inner Mongolia were selected and divided into two groups according to the disease area,with 37 patients in each group in the east and west regions.The control group received routine nursing and discharge guidance in respiratory department.The intervention group performed discharge preparation services based on focused solution approach on the basis of routine care.The two groups were compared in terms of discharge readiness,discharge guidance quality,self-management ability,disease uncertainty level,unplanned readmission,readmission interval,length of stay and hospitalization cost,and the intervention effect was evaluated.SPSS24.0 was used for data collation and analysis.Results1.Finally a total of 70 subjects were included in this study(two samples were dropped from each group),35 in the control group and 35 in the intervention group.There was no statistical significance in the baseline comparison of general demographic data and general clinical disease data between the two groups(P>0.05),indicating that the two groups were comparable.2.Intervention effect of discharge preparation service based on focused solution approach in elderly COPD patients:(1)Before intervention,the scores of self-management ability,discharge readiness,discharge guidance quality and disease uncertainty level in 2 groups were no significant differences.(P>0.05);(2)After intervention,the total score and scores of all dimensions of discharge readiness in the intervention group were higher than those in the control group,and the difference was statistically significant(P<0.05);The scores of each dimension of discharge readiness in the two groups from high to low were personal status dimension score,anticipatory support dimension score and adaptive ability score.(3)After intervention,the total score of discharge guidance quality in the intervention group was higher than that in the control group,and the difference was statistically significant(P<0.05);The actual content score of the control group was lower than the content score required for discharge,and the actual content score of the intervention group was higher than the content score required for discharge,and the difference between the two groups was statistically significant(P<0.05).(4)At discharge,1 month after discharge and 3 months after discharge,the total score of self-management ability and the scores of all dimensions,MUIS-A score in the intervention group were higher than those in the control group,with statistically significant differences(P<0.05);Repeated measure ANOVA of self-management score and MUIS-A score in 2 groups had time effect,intergroup effect and interaction effect,and the differences were statistically significant(P<0.05).(5)The rate of unplanned readmission within 3 months after discharge in the intervention group(17.14%)was significantly lower than that in the control group(54.29%),and the difference was statistically significant(P<0.05);The time between readmission in the control group was shorter than that in the intervention group,and the difference was statistically significant(P<0.05).(6)There were no significant differences between the intervention group and the control group in hospitalization cost and total hospitalization cost during the intervention(P>0.05).Conclusion Compared with conventional discharge guidance,application of an discharge readiness services intervention based on a focused solution approach can effectively improve the elderly patients with COPD self-management ability,discharge readiness,improve the quality of medical staff of the discharge guidance,extend the readmission in patients with interval,reduce the patient’s disease uncertainty level,unplanned readmission rate. |
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