ผลของการจัดการผู้ป่วยรายกรณีในผู้ป่วยโรคหลอดเลือดสมองแตกต่อระยะวันนอน ค่าใช้จ่ายในโรงพยาบาล และความพึงพอใจของทีมสหสาขาวิชาชีพ Effect of Case Management for Hemorrhagic Stroke Patients on Length of Stay, Cost of Care and Provider’s Satisfaction

Abstract

This quasi-experimental research aimed to investigate the effects of case management for hemorrhagic stroke patients on length of stay (LOS), cost of care, and provider^, s satisfaction. The study sample was composed of 60 new patients diagnosed with hemorrhagic stroke and admitted to inpatient Ward 3E at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The sample were divided into two groups: one experimental group received care from Registered Nurses and multidisciplinary team by using case management and one control group received routine care). Each group consisted of 30 patients selected by a purposive sampling to meet specific requirements. With respect to the similarity between the experimental and the control groups, the patients were matched, based on the variables such as similar gender, age, and comorbidities.  Registered nurses and the multidisciplinary team of 25 persons worked together and used a clinical pathway to provide care for hemorrhagic stroke patients. Research instruments were 1) the clinical pathway based on evidence-based practice developed by the researcher and the multidisciplinary team, 2) a form to record length of stay (LOS), 3) a form to record cost of care and 4) a questionnaire of provider's satisfaction with the case management. Instrument validity was reviewed by five experts. Reliability testing of the provider’s satisfaction questionnaire was computed by using Cronbach^, s alpha coefficient which were 0.97. Data were analyzed through a standardized statistical program SPSS version19 and reported in terms of descriptive statistics, percentage, mean, and standard deviation. The independent t-test was used to analyze mean differences of LOS, cost of care, and provider’s satisfaction between the experimental and the control groups. Results of this study had been founded that the experimental group reported statistically significant mean score LOS (M =8.07, SD=1.59) less than the control group (M= 9.57, SD=2.96) (t=2.43, p=.00); 2) the mean score cost of care in the experimental group (=117,359.81 Baht, SD=25,561.74 ) less than the control group (=134,603.28 Baht SD=35,011.70 ) (t=2.17p=.01); and 3) a high level of overall provider^,s satisfaction with the case management (=4.02 SD=.56). This study suggested to review and revise the clinical pathway based on new evidence-based practice yearly. Estimated length of stay (LOS) should be reviewed and decreased from the previous year while maintaining quality patient care and best outcomes.