The development of discharge planning model via multidisciplinary collaboration for Stroke patients.

Abstract

This action research aimed to develop the discharge planning model via multidisciplinary collaboration for stroke patients  in order to manage effective patient care. The samples of 20 stroke patients, their caregivers, and 5 multidisciplinary team members, were purposively selected. The data collection was

 done by the researchers through the use of the demographic questionnaire, structured discharge  interviewing form, and  the outcome assessment tool.  The results revealed that the discharge planning model consisted of three essential parties, including health care customers, health care providers, and payers. These parties interacted with each other in the focus of patient-centered care while nurses were taking an active role in coordinating for continuity of care. The model implementation resulted in positive outcomes including  reduction of the hospital length of stay as well as  hospital care expenses.