The effect of evidence-based discharge planning on the health outcomes of stroke patients with dysphagia: A prospective cohort study

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).

本研究旨在评估基于证据的出院准备服务方案对降低吞咽障碍（dysphagia）脑卒中患者非计划再入院率、误吸发生率，提升其出院准备度、自我管理能力与安全进食能力的效果。研究数据显示，该基于证据的出院准备服务方案可显著降低吞咽障碍脑卒中患者的非计划再入院率与误吸发生率，并显著提升患者的出院准备度、自我管理能力及安全进食能力。本研究按病房分组，设置神经内科1病区与神经内科2病区，以避免暴露组与非暴露组间的接触交流导致干预方案受到污染。本研究采用自然分组法，依据纳入排除标准，将入住神经内科1病区的患者分配至暴露组，入住神经内科2病区的患者分配至非暴露组。本研究共连续纳入符合标准的患者90例，分配至暴露组与非暴露组。暴露组接受研究团队制定的基于证据的出院准备服务方案，方案内容涵盖入院至出院前的早期再入院风险评估、动态评估、患者吞咽功能干预、营养支持、康复训练与健康教育，个体化出院计划，以及出院后7天与30天的电话及微信随访。非暴露组接受常规护理，护理时长与随访频率与暴露组保持一致。经过培训的研究助理收集所有患者入院时（T0）的基线数据；通过医院信息系统、电话及微信随访记录患者的非计划再入院与误吸发生情况；分别于出院当日（T1）、出院后7天（T2）及出院后30天（T3），采用脑卒中患者出院准备度量表（Stroke Patient Discharge Preparation Scale）评估患者的出院准备度，采用脑卒中自我管理能力量表（Stroke Self-Management Ability Scale）评估其自我管理能力，采用脑卒中吞咽障碍患者安全进食评估量表（Stroke Dysphagia Patient Safe Feeding Assessment Scale）评估其安全进食能力。