Construction Of Transitional Care Service Framework For Bladder Cancer Patients

Objective:To transfer care from hospital to home for bladder cancer patients, to insure that the effect of hospital treatment and rehabilitation can transfer to home so that decrease rehospitalization rate. This research was conducted to develop scientific and reasonable Transitional service framework for bladder bancer patients by introducing the transitional care service framework into the discharge care of bladder patients so as to optimize the continuing care service for bladder cancer patients and provide scientific evidence for future government decisions and policies on health service of patients with bladder cancer and powerful reference for the study of the transitional care service framework for other disease.Methods:1. The framework of Transitional Care service for bladder bancer patients was initially formed by theoretical analysis, literature review and expert panel discussion analysis. 2. The index structure of final formation of Transitional Care Service Framework for bladder bancer patients was developed by two round Delphi expert consultation.30experts was invited.27of them responded in the first round and26in the second round, mathematical statistics was used to calculate the coefficient of variation(CV) and analyze the other indexes of expert opinionsto test thereliability and validity of expert consultation.Results:1. The first draft of the Transitional Care Service Framework for bladder bancer patients was built through theoretical analysis and literature review, the service framework included4first-level indicators,14secondary index and46tertiary indicators, the draft was designed as the first-round questionnaire for expert consultation.2. Through two rounds of Delphi expert consultation, the indices of the Transitional Care Service Framework for bladder bancer patients was established, including institutional function, path, core link and service content of transitional care.4first-level indicators,13secondary index and42three-level index were contained. Superiority chart and experts assignment method were used to to determine the weight of the index at all levels and on this basis, the Transitional Care Service Framework for bladder bancer was developed.3. Reliability analysis of Delphi expert consultation:30copies of the questionnaire was distributed in the first round.27of them was back colllected with the90%response rate, and26was valid with the96.3%effective rate.18(69.2%) experts put forward proposal69.2%;26copies of the questionnaire was distributed in the second round.26was collected back and all are valid questionnaire with100response rate and effective rate;4(15.4%) expert gave advice which suggested that experts have high enthusiasm on this study; the authority coefficient of every expert was over0.70and the authority coefficient of expert groupwas0.8or above which indicated that the experts panel has high authority; The smaller the coefficient of variation of the expertswas, the higher the coordination degreewas.the general variation coefficient was required lower than0.25. In this study, the coefficient of variation of the second round range from0.04to0.204. Besides the average coefficient in second round(0.115) was lower than in first round(0.202), which indicated that coordination degree of experts was improved and their opinions tend to be more consistent. the higher the coordinate coefficient W was, the coordication among experts higher. In this study, the test of the coordinate coefficient was significant(P<0.001) which suggested that the coordination degeree of experts was good.Conclusion:The transitional care of service Framework bladder cancer patients was develped by literature review, theoretical analysis and two round Delphi experts consultation. Considering hospital service, community service, mutual cooperation between hospital and community and information sharing between agencies et.al. multi-dimension, this study has built a blueprint that hospital, community and patients work together to optimize care mode for bladder cancer patients in oder to meet the health needs of patients in different stages especially stage after discharge. The transitional care service framework built in this study reflected the three core connotation of transitional care: information, relationship and management.1. The service framework makes the service extending from hospital to community more operational by discharge planning, referral coordination and information sharing platform.2、 The service framework puts forward guidance idea of the cohesion and interaction between hospital and community service, and gives full emphasis on the important role of community in the care of discharge patients.2. This pattern has been clear about role and function of the hospital and community in continuing care of bladder cancer patients, established the pathway of transitional care for bladder cancer patients and clarify the specific service form and content of transitional care.