Phaholpolpayuhasaena Hospital Care Management Model for Ischemic Stroke Patients to Enhance Activity of Daily Living: OIMCCE Model

Abstract

ABSTRACT

          Objective: Ischemic stroke is a major health problem in Thailand because of its high prevalence, high mortality and dependence. Although, current advanced technology leads to an increase of survival rate, there are some gaps in care management and seamless care system. Therefore, the researchers undertook the research and development research design of this study. This study aimed to 1) explore situations of care management system for ischemic stroke patients of Phaholpolpayuhasaena Hospital; 2) develop the Care Management Model to Enhance Activity of Daily Living; and 3) examine the effect of developed care management model to enhance activity of daily living of Phaholpolpayuhasaena Hospital: OIMCCE Model.

          Methods: Research and development research design was used for this study which had three phases. Phase I, the situations of care management system for ischemic stroke patients of Phaholpolpayuhasaena Hospital; data including previous and current care management system, issues and needs of care, were collected from reviewing patient charts, interviewing 10 dyads of stroke patients and their caregivers and nine interdisciplinary teams involving in stroke care and observing real situation of stroke care. Data were analyzed using content analysis.  Phase II, development of the care management model to enhance activity of daily living; an appropriate care management model were developed based on results from phase I. Phase III, the effect of developed care management model to enhance activity of daily living for stroke patients receiving care in Phaholpolpayuhasaena Hospital were examined using quasi experimental research: two groups pretest posttest design.  Sixty dyads of stroke patients and their caregivers who met the inclusion criteria were recruited to this phase and randomly assigned into two groups: an intervention group receiving the developed care management system and a control group receiving normal care management system.  Research instrument included 1) the developed stroke care management model 2) Bathel ADL measurement, caregivers competence evaluation, and satisfaction evaluation. Reliability tests of research instruments were 0.89 and 0.82 respectively. Frequency, percentages, mean, standard deviations and independent t test were applied for this study.

                Results: the result of phase I revealed that the previous care management model  was good but there were some obstacles: 1) door to needle time was higher than the criteria because of a lack of personnel experience in stroke care and emergency department nurses felt uncomfortable to care for stroke patients during receiving medication;  2) there was no mutual goal among interdisciplinary team and caregivers; and 3)  lack of effective discharge planning and referring back to homes based on the phase I results, the new stroke care management model (OIMCCE) including 1) mutual goal /objective arrangement among stroke patients, caregivers and interdisciplinary team (objective); 2) mutual working among interdisciplinary teams (interdisciplinary team);  3) Management;  4) clinical practice using nursing process and clinical practice guideline (clinical practice); 5) caregivers’ competence improvement and seamless care (caregivers’ ability); and 6) evaluation and home visit. (evaluation). Phase III results were  1)  average scores of activity of daily living score, caregivers ability score, satisfaction score of the intervention group were higher than the control group statistical significantly (p<.05).  Dyads of stroke patients and caregivers satisfied the care at high level (M=3.95, SD=0.28).  All interdisciplinary teams satisfied on the developed care management model (100%) and no major complications of stroke patients in the hospital and after discharging.

                 Conclusion: The developed stroke care management model of Phaholpolpayuhasaena Hospital can be implemented and improve activity of daily

living of stroke patients and caregivers’ ability. Therefore, this model can be applied widely to provide an effective care for stroke patients and their caregivers.

living of stroke patients and caregivers’ ability. Therefore, this model can be applied widely to provide an effective care for stroke patients and their caregivers.