West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Emergency Department, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi 563000, Guizhou, China; School of Nursing, Zunyi Medical University, Zunyi 563000, Guizhou, China.
Department of Urology/Institute of Urology/Organ Transplantation Center,West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
Int J Nurs Stud. 2020 Oct;110:103700. doi: 10.1016/j.ijnurstu.2020.103700. Epub 2020 Jun 26.
Kidney transplantation is the major treatment for end-stage renal disease (ESRD). However, kidney transplant recipients (KTRs) face severe challenges during the transition period from hospital discharge to home, increasing the risk of early hospital readmission (EHR) and affecting patient safety. Nevertheless, knowledge of effective transitional care for KTRs is limited in China.
To evaluate the effectiveness of an innovative transitional care program in improving discharge readiness, transitional care quality, health services utilization and patient satisfaction among KTRs in China.
A prospective randomized controlled trial.
Patients admitted to undergo kidney transplantation were recruited in a general tertiary hospital in Chengdu, China.
A total of 220 eligible patients were recruited and randomly assigned to the intervention and control groups. Participants in the intervention group received a transitional care intervention developed by the research team, including a risk assessment for early readmission, health education from admission to predischarge, individualized discharge planning, and a telephone follow-up once per week for one month and WeChat follow-up postdischarge. The control group received routine care of comparable length and follow-up contact. A trained research assistant collected all patients' baseline data on admission (T0), evaluated the discharge readiness (by the Readiness for Hospital Discharge Scale) on the day of discharge (T1), collected data on transitional care quality (by the Care Transition Measure-15) and patients' satisfaction with transitional care services (by a self-developed patient satisfaction scale) on the 30th day postdischarge (T2), and collected data on hospital readmission, unscheduled outpatient department visits, and emergency room visits on the 30th and 90th days (by a self-developed health services utilization record table) (T3) postdischarge. Intervention effects were analyzed using independent samples t-tests, Wilcoxon-Mann-Whitney U tests, Chi-square tests or Fisher's exact test.
Compared with the control group, the intervention group showed significantly better discharge readiness (personal status, P<0.001; knowledge, P = 0.010; coping ability, P<0.001; expected support, P = 0.007; total score, P<0.001), better transitional care quality (importance of preferences, P<0.001; management preparation, P<0.001; critical understanding, P = 0.003; written and understandable care plan, P = 0.012; total score, P<0.001), lower readmission rate at T2 (P = 0.033) and at T3 (P = 0.013), lower emergency room visit rate at T3 (P = 0.014), and better satisfaction with transitional care services (P<0.001).
This study provides evidence that an innovative transitional care program is effective in promoting KTRs' discharge readiness, transitional care quality, reducing hospital readmission and emergency room visits, and improving their satisfaction with transitional care services.
Clinical Trials ChiCTR1800014971.
肾移植是治疗终末期肾病（ESRD）的主要方法。然而，肾移植受者（KTR）在从医院出院到回家的过渡期面临严重挑战，增加了早期医院再入院（EHR）的风险，并影响了患者的安全。然而，中国对 KTR 有效的过渡性护理知识有限。
评估一种创新的过渡性护理方案在提高出院准备度、过渡性护理质量、卫生服务利用和 KTR 患者满意度方面的有效性。
前瞻性随机对照试验。
在中国成都的一家综合三级医院招募接受肾移植的患者。
共招募了 220 名符合条件的患者，并随机分为干预组和对照组。干预组患者接受了由研究团队开发的过渡性护理干预，包括早期再入院风险评估、从入院到出院前的健康教育、个体化出院计划以及出院后每周一次、持续一个月的电话随访和微信随访。对照组患者接受了同等长度的常规护理和随访。一名经过培训的研究助理在入院时（T0）收集所有患者的基线数据，在出院当天（T1）评估出院准备情况（通过出院准备量表），在出院后第 30 天（T2）收集过渡性护理质量（通过过渡性护理措施-15 量表）和患者对过渡性护理服务的满意度（通过自我开发的患者满意度量表）的数据，并在出院后第 30 天和第 90 天（通过自我开发的卫生服务利用记录表）收集医院再入院、非计划性门诊就诊和急诊就诊的数据（T3）。使用独立样本 t 检验、Wilcoxon-Mann-Whitney U 检验、卡方检验或 Fisher 精确检验分析干预效果。
与对照组相比，干预组患者出院准备度（个人状况，P<0.001；知识，P=0.010；应对能力，P<0.001；预期支持，P=0.007；总分，P<0.001）、过渡性护理质量（偏好的重要性，P<0.001；管理准备，P<0.001；关键理解，P=0.003；书面和易懂的护理计划，P=0.012；总分，P<0.001）均显著改善，2 天（P=0.033）和 3 天（P=0.013）时再入院率降低，3 天（P=0.014）时急诊就诊率降低，过渡性护理服务满意度更高（P<0.001）。
本研究表明，一种创新的过渡性护理方案能够有效提高 KTR 的出院准备度、过渡性护理质量、降低医院再入院和急诊就诊率，提高其对过渡性护理服务的满意度。
ClinicalTrials ChiCTR1800014971。
