Development of a Case Management System for Acute Ischemic Stroke Patients
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Abstract
The research and development aim to: 1) develop a case-based management system for patients with acute ischemic stroke, and 2) study the outcomes of the case-based management system for patients with acute ischemic stroke at Nopparat Rajathanee Hospital. The research was conducted between August 17, 2022, and May 9, 2023, divided into four phases: 1) planning phase, 2) implementation phase, 3) observation phase, and 4) reflection phase. The purposed sampling consisted of 11 professional nurses and 60 patients who received treatment for acute ischemic stroke. Data were collected by using five questionnaires, including personal information, assessment of neurological severity, follow-up assessment of case management outcomes, nurse satisfaction assessment, and nurse knowledge test. The Cronbach's alpha reliability coefficients were .85, .93, and .94 for the respective instruments. Statistical analysis was performed using descriptive statistics, Wilcoxon signed-rank test and Mann-Whitney U tests. The research findings revealed that:
1. The developed case management system included: 1) fast-track service system, including patient screening, monitoring, and evaluation; 2) individualized counseling system; and 3) follow-up system for patients returning home during at 1, 2, and 4 weeks.
2. After implementing the system: 1) Nurses' knowledge and satisfaction significantly increased compared to before system use (Z = 52.00, p < .05; Z = 65.00 p < .01); 2) Patient outcomes showed significant reduction in neurological deterioration, aspiration pneumonia, urinary tract infections, pressure ulcers (F = 6.30, 6.56, 6.30, 6.56; p < .05). However, hospitalization costs and length of stay did not differ significantly.
The developed system effectively reduced complications, and trends suggested potential reduction in costs and hospital stays. The role of nurses is crucial in system development, improving communication, and enhancing treatment efficiency.
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