| Objective:Based on the great challenge of disease control and rehabilitation of COPD patients after discharge from the hospital and the lack of assessment tools for discharge preparation,this study constructed a COPD patient discharge preparation evaluation form suitable for clinical application,aiming to early assess the risk of COPD patients preparing for discharge from high-risk groups.And comprehensively evaluate the discharge preparation needs of COPD patients,and provide a basis for them to formulate a personalized discharge preparation plan.Methods:This study was designed as a mixed study.Firstly,a draft index system of discharge preparation service evaluation for COPD patients was formed by literature analysis.After,Meta analysis and semi-structured interview were used to revise the preliminary index system,and an expert consultation questionnaire was formed to evaluate the index system of discharge readiness service for COPD patients.Then,With the help of Delphi expert consultation method and analytic hierarchy process(AHP),the evaluation index system of discharge readiness of COPD patients and the weight of each level index were established.Finally,based on the index system,an evaluation form for discharge readiness of COPD patients after pre-test was constructed.The details are as follows:1.A systematic search of relevant studies on discharge readiness assessment for COPD patients in CNKI,VIP,Wanfang,Pub Med,Science Direct,Geen Medical and other domestic and foreign databases was conducted,and relevant literatures were reviewed and analyzed to understand the status quo of discharge readiness assessment for COPD patients.A draft evaluation index system for discharge readiness of COPD patients has been formed.2.The databases of CNKI,Wanfang,VIP,Pub Med,Web of Science and Cochrane Library were systematically searched,and clinical cohort studies,case-control studies and cross-sectional studies on risk factors for prolonged hospital stay in COPD patients were collected.Note Express and Rev Man 5.3 software were used to sort out and analyze the literature contents.Meta-analysis of risk factors for prolonged hospital stay of COPD patients was carried out to supplement the preliminary draft evaluation index system for high-risk groups of patients with discharge preparation of COPD patients.The literature related to the discharge requirement of COPD inpatients was reviewed,and the interview outline was formulated.Twelve readmission patients with chronic obstructive pulmonary disease in a third-class A hospital from July to August 2020 were selected for data analysis using the Colaizzs 7-step analysis method.A qualitative study on the discharge preparation needs of readmitted COPD patients was conducted.To supplement the draft evaluation index system of discharge preparation needs for COPD patients.An expert consultation questionnaire was formed to evaluate the index system of discharge readiness for COPD patients.3.Select the domestic experts in the field of clinical care and management of COPD index system of expert consultation,combined with expert advice and amend the result evaluation index system,the analytic hierarchy structure model is established based on the evaluation index system,in the third round of the expert advisory importance assignment between the various indicators of mean difference to determine Satty scale,determine the model of index system of the matrix.Finally,the weights of each index,the combined weights and the consistency coefficient(CR value)are automatically output.A final index system for the evaluation of discharge readiness for COPD was established.4.Based on the evaluation index system of discharge readiness for COPD patients,a discharge readiness evaluation form for COPD patients suitable for clinical use was constructed,and the reliability and validity of the pre-test was tested by convenience sampling method and selecting 18 discharged COPD patients from a third-class A hospital who met the admission and discharge standards in March 2021.Develop the final discharge readiness assessment form for COPD patients.Results:1.The theoretical framework of discharge readiness evaluation index system for COPD patients was formed by integrating the discharge readiness implementation process in the "elderly patient discharge readiness expert consensus" and the discharge planning process in the conceptual model of discharge readiness proposed by WIESS abroad.At the same time,by referring to the existing research contents of discharge readiness assessment for COPD patients at home and abroad,a draft index system of discharge readiness service assessment for COPD patients was initially formed,including3 first-level indicators,17 second-level indicators and 52 third-level indicators.2.According to the results of Meta analysis and semi-structured interview,the primary indicators of discharge readiness service evaluation system for COPD patients,namely screening indicators for high-risk groups of COPD patients and indicators for discharge readiness needs of COPD patients,were modified and supplemented.A questionnaire was formed to evaluate the indicators system of discharge preparation service for COPD patients,including 3 first-level indicators,16 second-level indicators and 61 third-level indicators.3.In this study,a total of 16 experts were selected for 3 rounds of Delphi expert consultation.Three rounds of expert consultation questionnaires were sorted out.According to indicator screening criteria,expert opinions and group discussions,the revised indicator system included 3 first-level indicators,17 second-level indicators and73 third-level indicators,and the indicator system for discharge readiness assessment of COPD patients was established.The recovery rates of the three rounds of expert consultation were 80%,100% and 100% respectively,and the authority coefficients of the experts were 0.838,0.860 and 0.891.The index coordination coefficients of the first, second and third rounds of expert consultation were 0.105～0.333,0.121～0.231 and0.123～0.260,respectively.The results show that the CR value of each matrix is less than0.1,and the index weights of each level are as follows:from high to low,the first-level index weights are:demand index(0.5396),basic information(0.2970),and screening index(0.1634).Among the secondary indicators,the highly weighted indicators were COPD drug guidance demand(0.1230),COPD symptom management demand(0.0889),and COPD rehabilitation exercise demand(0.0889).Among the three indexes,the ones with higher weight were the guidance of expectorant use(0.0486),the management of edema(0.0444),and the need for cognitive guidance of pulmonary rehabilitation exercise(0.0444).4.Pre-test results show that Cronbach’s α of each item in the evaluation form is0.856,I-CVI is 0.800-1.000,and S-CVI is 0.803.All of them are within the acceptable range and have good reliability and validity.Conclusion:1.The evaluation form was completed through Meta analysis,qualitative study,3rounds of Delphi expert consultation,group discussion.The pre-test is constructed and revised,which has good scientific nature and comprehensiveness.The results of the three rounds of expert consultation showed that the experts were highly active and authoritative,and their opinions were well coordinated.The reliability and validity of the clinical pre-test of the evaluation form was good,and it had good reliability.Through the analysis of the weight of the index system and the revision of the evaluation form for preliminary clinical application,it has good practicability.2.An evaluation form of discharge readiness for COPD patients was finally formed,including 3 items of level I,13 items of level II and 50 items of level III.In order to clarify the key issues of discharged COPD patients,it is of great practical significance to construct and implement a personalized discharge preparation plan and form a discharge preparation process for COPD patients,so as to reduce the discharge risk of COPD patients and achieve discharge readiness. |
