Development of a Homeward Care Model for Patients with Chronic Diseases in a 30-Bed Community Hospital: A Case Study of Nonsang Hospital, Nong Bua Lamphu Province

Abstract

     This research and development study aimed to examine care needs, develop and evaluate a Homeward care model, and assess its expansion at Nonsang Hospital, Nong Bua Lamphu Province, Thailand. The study included four phases: situation analysis, model development, implementation and evaluation, and refinement and expansion. Quantitative and qualitative data were collected. Clinical outcomes were assessed in 303 patients with diabetes receiving Homeward care and 286 hospital inpatients, without random allocation. We assessed self-care and perceived health in 110 patients per group. The expansion phase included 150 new patients. Instruments included interview guides, clinical records, the Self-Care of Chronic Illness Inventory, EQ-5D-5L, and a satisfaction questionnaire. Data were analyzed using descriptive statistics, chi-square tests, Welch’s t-tests, paired t-tests, analysis of covariance, and content analysis.

     Patients experienced travel difficulties and needed continuous follow-up. The model comprised five components: readiness assessment, individualized care planning, patient and caregiver preparation, follow-up and coordination, and management of abnormal symptoms and outcome evaluation. Mean HbA1c decreased by 0.90 percentage points in the Homeward group and increased by 0.32 percentage points in the inpatient group. However, the between-group difference was not significant after adjustment for initial HbA1c (p = .281). The Homeward group had lower self-care and confidence scores but higher satisfaction scores (p < .001). EQ VAS scores did not differ significantly (p = .235). During expansion, 92.7% completed scheduled follow-up. Among patients with paired measurements, mean HbA1c decreased by 0.57 percentage points (p < .001), whereas EQ VAS scores did not change significantly.