Construction And Preliminary Application Of Home-based Health Management Practice Program For Elderly Stroke Patients

ObjectiveBased on KTA,this study comprehensively searches the relevant documents of home health management of elderly stroke patients through literature research method,forms the best evidence of home health management of elderly stroke patients,constructs a complete,scientific and specific home health management practice plan for elderly stroke patients according to the best evidence,and verifies the scientific and effectiveness of the plan through similar experimental research.Methods1.Using the literature research method,search,screen and evaluate the guidelines,consensus,and systematic evaluation of home health management of elderly stroke patients at home and abroad,extract high-quality evidence,and grade the included evidence to form a summary of evidence of home health management of elderly stroke patients,invite clinical experts related to stroke to conduct expert group demonstration,and discuss the level of evidence recommendation with reference to FAME model proposed by JBI,So as to form the evidence summary and recommendation level suitable for domestic clinical situations.2.Use observation and interview methods to understand the possible promotion and obstacle factors in the home health management practice of elderly stroke patients,and formulate corresponding reform strategies to form the first draft of the plan,and use expert meeting method to revise and improve the preliminary draft of the plan,and finally determine the home health management practice plan of elderly stroke patients.3.Using quasi-experimental research methods,routine health management was carried out for patients who met the inclusion and exclusion criteria in the Department of Neurology of a Class III Class A hospital in Shanghai from July 2022 to September 2022 as a historical control group;The elderly stroke patients who met the inclusion and exclusion criteria from October 2022 to December 2022 were taken as the intervention group to implement the home-based health management plan for elderly stroke patients,to explore the impact of the plan on the blood pressure,blood glucose,blood lipids,daily activity ability,quality of life,psychological status and family function of elderly stroke patients,and to verify the scientific and effectiveness of the constructed plan Result1.After searching and screening,a total of 17 documents were included.After evidence extraction and summary,a total of 71 evidences of home-based health management for elderly stroke were extracted.After expert meeting,2 evidences were removed and 11 evidences were merged,and finally 58 evidences were formed,including target population,implementation time,implementation form,multidisciplinary collaboration,evaluation,lifestyle and risk factor management,rehabilitation management,medication management,fall prevention and management The best evidence summary of home health management for elderly stroke patients with 13 themes of psychological adjustment,health education,social support and quality control.2.Based on the best evidence summary,through observation and interview,we learned that there was a large gap between the clinical situation and the application of evidence.The research team brainstormed to develop corresponding change strategies and determined the first draft of the plan,including 3 first-level items,14 second-level items and 49 third-level items;Invite 10 experts engaged in stroke treatment or nursing to carry out the expert meeting to revise the plan formed in the early stage,and the authority coefficient(Cr)of the experts is 0.885.The final home health management practice plan for elderly stroke patients,which is constructed by revising,sorting out and improving the draft,includes 5 first-level indicators,18 second-level indicators and 56 third-level indicators.3.A quasi-experimental trial was conducted,with 42 patients in the control group and 42 patients in the intervention group,of which 5 cases were dropped out of the control group(1 case left Shanghai,2 cases died of aggravation,and 1 case lost contact),and 3cases were dropped out of the intervention group(1 case left Shanghai,1 case died of aggravation,and 1 case refused to participate in the follow-up study after 1 month of intervention).Finally,76 study data were collected,including 39 in the intervention group and 37 in the control group.The results showed that the baseline data of patients in the two groups were not statistically significant(p>0.05).After implementing the health management plan,the clinical indicators,activities of daily living,quality of life,mental health status,and family functions of patients in the intervention group were significantly better than those in the control group,with significant differences(p<0.05).Conclusion1.Based on the KTA theory,this study finally formed a home-based health management practice plan for elderly stroke patients through literature research,observation,interview and expert meeting,including five level-1 items,including team formation,intervention method,intervention process,intervention content,and effect evaluation.Through the implementation plan of multidisciplinary team members,it can provide certain guidance for the home-based health management practice of elderly stroke patients.2.The results of non-synchronous controlled clinical study showed that the patients in the intervention group had good control of blood sugar,blood pressure and blood lipids,improved ability of daily living,improved quality of life,reduced negative emotions,and enhanced family functions,which verified the scientific and clinical applicability of the program.