Development of Continuity of Care Model for Stroke Patients

Abstract

Purposes : To study the problem, develop a model, and evaluate the use Continuity of Care Model for Stroke Patients.

Study design : Action Research.

Materials and Methods : Twenty three were consisted of key informants stroke patients discharged from Roi-Et Hospital who recruited the inclusion criteria and a multidisciplinary team. Data were collected using the ability to assess ability to perform daily activities and a satisfaction assessment form. Data were analyzed using frequency, percentage, mean, and standard deviation, and inferential statistic such as repeated measure ANOVA.

Main finding : (1) The problem of continuing care was not yet covered in all cases, communicating and passing information in a multi-disciplinary team and in the network and lack of continuity in home visits. (2) Home continuation care model were consisted of receiving patients, determining the method of visiting, excellent team performance and record entry; and (3) Home visit results; After receiving continuation of care at home for 6 months, it was found that stroke patients had an increase in mean scores of ability to perform daily activities more than before continuation of care at home (p<.05).

Conclusion and recommendations : The results of this study show that continuing care at home as a result, patients have ability to perform daily activities increased.