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).