Outcomes of Intermediate Care Program for Neurological Patients in Neurological Institute of Thailand
Tipyarat Saringcarinkul¹, Natnicha Ramnanee², Nittaya Klongyuth², Thongkhao Samkumpim²
Affiliation : ¹ Department of Rehabilitation, Neurological Institute of Thailand, Bangkok, Thailand, ² Nursing Department, Neurological Institute of Thailand, Bangkok, Thailand
Background: Intermediate care (IMC) is important for enhancing physical and mental performance and reducing disability of the post-acute patients
with medically stable conditions. Neurological Institute of Thailand (NIT) is a specialized institute in neurology with IMC readiness in terms of
multidisciplinary approach in rehabilitation. It has a specific ward for rehabilitation medicine to implement the IMC inpatient program since 2018.
Objective: To investigate the NIT’s IMC inpatient program for functional gain, effectiveness, and efficiency to obtain the empirical data for further developing the IMC.
Materials and Methods: The present study was a prospective descriptive research, collecting the data from 91 neurological patients of the IMC inpatient program. In the data analyses, the patients were classified into three groups by the Barthel’s index (BI) with Group 1 as very severely disabled (BI 0 to 5), Group 2 as severely disabled (BI 6 to 10), and Group 3 as moderately disabled (BI 11 to 15). The primary outcomes of the study were function gain [ΔBI = BI after IMC – BI admission], effectiveness [Eff = ΔBI / (20 – BI admission) * 100], and efficiency [Efc = ΔBI / Length of stay (LOS in days)]. The secondary outcomes were change of overall disability level assessed by the modified Rankin Scale (ΔMRS) and the quality-of-life measured by two parts of EQ-5D-5L (EQ1, EQ2).
Results: The mean LOS of IMC inpatient program was 36.73±19.30 days. At discharge (dc), the overall means of ΔBIdc, Effdc, and Efcdc were 5.83±3.62, 44.82±24.38, and 0.20±0.15, respectively. The mean of ΔMRSdc reduced 0.69±0.61, while the means of EQ1dc and EQ2dc increased at 0.56±0.27 and 66.14±15.17 from the admission. In the analyses of the group comparison, the significant statistical differences were found at Effdc, MRSdc, and EQ1dc. At the 6-month follow-up (six), the means of BIsix, Effsix, EQ1six, and EQ2six increased in the three groups, in which the highest mean Effsix was found in Group 3 and the most reduced MRS (ΔMRSsix) was found in Group 2.
Conclusion: The IMC inpatient program at NIT can enhance performance, reduce disability, and increase quality of life of the neurological patients. The most effectiveness of the IMC program was found in the group of the moderately disabled patients.
Received 6 January 2022 | Revised 2 May 2022 | Accepted 10 May 2022
DOI: 10.35755/jmedassocthai.2022.06.13327
Keywords : Immediate care; Neurological patients; Outcomes; Effectiveness; Efficiency; Quality of life
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