The Development of home visit service system and continuity of care for stroke patients at Mahasarakham Hospital, Mahasarakham Province

Abstract

ABSTRACT

Objective : To study the problem situation and development of home visit service system and continuity of care for stroke patients at Mahasarakham Hospital.

Methods : This research is “Research and Development” by system developers, 43 people, 414 rehabilitation stroke patients in 2017-2019, consisted of 5 steps 1) Surveying problems and needs 2) Designing activities 3) Experimental practice 4) Evaluate the performance 5) Disseminate. Analyze data using descriptive statistics, Friedman test and Wilcoxon signed rank test and content analysis.

Results: There were 9 processes, develop a nursing care system linked to the caring network,  develop a continuous care system, develop proactive service provision in the community, develop a passive service system, develop a strong care network, make participation  and provide services to connect with the community,develop a community nursing quality assurance, Make a manual and disseminate the innovation “Participation in self  reliance in health rehabilitation”

Conclusion : These research and development  found that knowledge about stroke and caring increased to 89.76% and 86.58%, satisfaction to home visit services and innovation  at high - highest level, 93.79 and 97.24% ,compared Barthel index of ADL scores at discharge and 6 months were significantly different, Asymp Sig 0.000.