Development of Quality of Intermediate Care Rehabilitation after Stroke, Community Hospitals Network, Phrae Province

Abstract

This research and development study aimed to develop and evaluate an intermediate care rehabilitation service system for stroke patients in the community hospital network of Phrae Province, Thailand. The study had two phases. Phase 1 included situation analysis and system development through focus group discussions with 38 personnel involved in stroke patient care. Phase 2 involved implementing and evaluating the system with patients who had intermediate-stage stroke, using a pre–post design with 30 participants in each group. Research instruments included the Barthel Index, the Thai version of the Stroke Rehabilitation Assessment of Movement, a length-of-stay record form, and a complication recording form during intermediate care. Additional questionnaires assessed feasibility and satisfaction with the developed system. Data were analyzed using descriptive statistic, chi-square test, Mann–Whitney U test, and Wilcoxon Signed Ranks test.

The research findings revealed that phase 1 of the research involved the development of a system consisting of 1) establishment of physical therapist case manager teams in community hospitals, 2) implementation of a Potential-Based Approach with standardized standing orders, and 3) a Line consult system for multidisciplinary consultation. In Phase 2, the post-development group demonstrated significantly better outcomes than the pre-development group (p < 0.05) across all major indicators, including discharge BI score (9.30 vs 6.20), maximum BI score (17.03 vs 13.33), BI effectiveness index (29.65% vs. 17.41%), and length of stay improvement (6.03 vs 3.70 days). STREAM scores also improved significantly (p < 0.00). Physical therapists reported high feasibility for implementation of the developed system (mean = 3.68, S.D. = 0.76) and the highest level of overall satisfaction (mean = 4.57, S.D. = 0.60).