Effect of the Development of Intermediate Care Service nn Activities of Daily Living and the Level of Disability in a Community Hospital

Abstract

Transitional care in sub-acute stroke patients is crucial for patient performance prognosis. This study aimed to examine the effect of developing an intermediate care (IMC) service on activities of daily living and disability levels in community hospitals. This action research had four phases per cycle: (1) Planning, (2) Action, (3) Observation, and (4) Reflection. The research period was between October 2021 and January 2022. The research tools consisted of (1) the Barthel index (BI) Thai version, (2) the Modified Rankin Scale (MRS), and (3) the service satisfaction. The problems with the previous intermediate care service were reported as incomplete rehabilitation, discontinuous home health care, and a lack of integration of patient care by multidisciplinary teams. Therefore, the patient’s healthcare was not covered. Descriptive and inferential statistics were applied to analyze data. Thirty-six patients were included, who consisted of stroke (n=34, 95%) and fragility fracture (n=2, 5%), aged >50 years. The BI score and MRS were compared at hospital discharge and monthly for 6 months. The BI score significantly increased from the first month (p<0.001), while the MRS score declined in the first month during rehabilitation service care. As a result, it indicated that the development of the IMC services, which continuously provide holistic care, effectively improved patients’ activities of daily living and decreased disability. Moreover, the service rates by the patients, caregivers, and multidisciplinary medical staff were highly satisfactory. This study could be broadly implemented in routine patient care for continuous care after discharge from a community hospital.