Effects of a discharge planning intervention for elderly patients with coronary heart disease in Tianjin, China : a randomized controlled trial

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Effects of a discharge planning intervention for elderly patients with coronary heart disease in Tianjin, China : a randomized controlled trial


Author: Zhao, Yue
Title: Effects of a discharge planning intervention for elderly patients with coronary heart disease in Tianjin, China : a randomized controlled trial
Degree: Ph.D.
Year: 2004
Subject: Hong Kong Polytechnic University -- Dissertations
Hospitals -- Admission and discharge -- China -- Tianjin
Coronary heart disease -- Patients -- Rehabilitation -- China -- Tianjin
Department: School of Nursing
Pages: v, 221 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1809911
URI: http://theses.lib.polyu.edu.hk/handle/200/2275
Abstract: Background: Elderly patients with chronic disease need continuity of health care during the transitional period following discharge from hospital to home. Comprehensive discharge planning models have been applied in developed countries such as the USA and the UK. However, the continuity of health care delivery during the transitional period is still underdeveloped in mainland China. It is critical to develop a continuous health care model during the transitional period and test the effects upon the elderly who have chronic illnesses such as coronary heart disease, dovetailing the acute phase of care with the rehabilitation phase in the community. It is important that this model takes into account the particular health conditions in mainland China. Objective: To test the effects of an original discharge planning and follow-up support program in mainland China during the transitional period of care for coronary heart disease (CHD) in elderly patients. The outcome measures of the program are: adherence to health recommendations; understanding of the general and the specific treatment goals; self-management of CHD risk factors; readmission rates and related costs; and the effectiveness on community support for CHD elderly. Design: This study used a randomized controlled trial to compare the effectiveness of a discharge planning protocol developed specifically for elderly Chinese hospitalized CHD patients. Subjects were followed-up for 4 weeks post-discharge by community nurses (CNS). Data was collected on four occasions: the day after getting patient's consent in hospital (baseline data); within two days after discharge; at the end of the fourth week after discharge; at 12 weeks after discharge. Setting: Data collection in hospital took place in the cardiac medical ward of Tianjin The First Central Hospital, one of the two largest hospitals in Tianjin, and also in the teaching hospital of the School of Nursing, Tianjin Medical University. This hospital provides comprehensive health care services for both local and non-local patients. Patients' follow-up in the study was conducted by the community nurses of Tianjin Wang Ding-Di community hospital which is located in Nan Kai district of Tianjin. Participants: Two hundred subjects screened for study participation, aged 60 years and older, were admitted from home (in the Nan Kai district of Tianjin) to Tianjin The First Central Hospital between September 2001 and April 2003 with a diagnosis of either angina or myocardial infarction. Intervention: The elderly CHD patients in both the study group and the control group received routine care. Patients in the study group received a discharge planning program which included assessment, health education and consultation before discharge; plus a discharge plan, patient referral, and continued education and consultation during the follow-up after discharge. Outcome Measures: Self-reporting based upon an understanding of the basic knowledge of CHD-related risk factors, CHD diet, CHD medications, and CHD physical exercise plus self-reported adherence to diet, medication, physical exercise, the daily practice of health related behavior, and the readmission rate. Results: Demographic factors, health and functional status were controlled. Compared with the control group, elderly CHD patients in the study group scored significantly higher on self-reported basic awareness for: CHD risk factors; diet; medication at 2 days, 4 weeks and 12 weeks post-discharge; and awareness about physical exercise at 4 weeks and 12 weeks post-discharge. (P<0.01). Similarly, self-reported adherence to diet and health-related daily behavior at 2 days, 4 weeks and 12 weeks post-discharge; medication adherence at 4 weeks and 12 weeks post-discharge; and physical exercise at 12 weeks post-discharge were all significantly higher in the study group than in the control group (p<0.05). But readmission rate between the two groups measured at 12 weeks post-discharge was not significantly different p>0.05. Conclusions: Study findings demonstrate that the discharge planning and follow-up support program may benefit the elderly CHD patients by enhancing CHD related knowledge and health behavior. This study suggests that a coordinated discharge plan and follow-up program is needed for elderly CHD patients in mainland China during the transitional period from hospital to home. If implemented by both clinical nurses and community nurses it could facilitate effective continuity of health care from hospital to community outcomes in the long term.

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