The effect of evidence-based discharge planning on the health outcomes of stroke patients with dysphagia: A prospective cohort study
Description
Objective of the study to evaluate the effects of an evidence-based discharge preparation services plan in reducing unplanned readmission rate, aspiration, improving readiness for hospital discharge, self-management ability, and safe feeding among stroke patients with dysphagia.Data of the study shows that an evidence-based discharge preparation services plan can significantly reduce unplanned readmission rate and aspiration in stroke patients with dysphagia, and significantly improving patients' readiness for hospital discharge, self-management ability and safe feeding. The study was grouped according to wards, Neurology Ward 1 and Ward 2, to avoid contamination of the intervention program by contact communication between the exposed and non-exposed groups. Using natural grouping method, patients admitted to Ward 1 were assigned to the exposed group, and patients admitted to Ward 2 were assigned to the non-exposed group, based on the inclusion and exclusion criteria.A total of 90 eligible patients were consecutively enrolled to the exposure group and non-exposure group. The exposure group received an evidence-based discharge preparation services plan developed by the research team, including early readmission risk assessment, dynamic evaluation, intervention for patients' swallowing function, nutrition, rehabilitation, health education from admission to predischarge, individualized discharge planning, telephone and WeChat follow-up at 7 and 30 days after discharge. The non-exposed group received routine care with the same length of care and follow-up as the exposed group. Trained research assistant collected all patients’ baseline data on admission (T0), recorded unplanned re-admission and aspiration (via hospital information system, telephone and WeChat follow-up), evaluated the readiness for hospital discharge (via the Stroke Patient Discharge Preparation Scale), self-management ability (via the Stroke Self-Management Ability Scale), and safe feeding (via the Stroke Dysphagia Patient Safe Feeding Assessment Scale) on the day of discharge (T1), 7 days post-discharge(T2), and 30 days post-discharge (T3).
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The unplanned readmission rate refers to an unexpected hospital readmission due to the same or related illness within a specified time period after discharge, typically calculated as the unplanned readmission rate within 30 days of discharge. The aspiration refers to the ratio of the number of patients who experience aspiration to the total number of patients during a given time period . and the data were collected via a self-designed record table.Readiness for hospital discharge was evaluated by the Readiness for Hospital Discharge Scale.Self-management ability was evaluated by the Stroke Self-Management Behavior Scale.Safe feeding was evaluated by the Stroke Dysphagia Patient Safe Feeding Assessment Scale.Baseline demographic or clinical data, such as the participants’ gender, age, educational level, Primary caregiver, comorbidities, presence of indwelling devices, Readmission risk and Swallowing function were collected.Two trained research assistants, after obtaining written informed consent, explained the purpose of the study, the requirements for completing the questionnaire. They were blinded to the patients' group allocation. Baseline data (T0) were collected at the time of patient admission. Data on unplanned readmission, aspiration, readiness for hospital discharge, self-management ability, and s safe feeding were collected on the day of discharge (T1), 7 days after discharge (T2), and 30 days after discharge (T3).All data were collated and quantified after validation by two people, then entered and stored in Microsoft Excel 2010. After confirming the accuracy of the data, statistical analysis was performed using R software （https://www.r-project.org/）. For normally distributed data, statistical descriptions were given as means and standard deviations, while non-normally distributed data were described using medians and interquartile ranges. Differences between groups were compared using independent sample t-tests or Wilcoxon rank-sum tests. Categorical data were described using frequencies and percentages, with comparisons made using chi-square tests or Fisher’s exact tests. Repeated-measures information was analyzed using two-factor repeated-measures ANOVA. All statistical tests were two-sided and the significance level was set at α = 0.05.