Developing an integrated care system for the elderly: CHATU MODEL Chaturaphakphiman Hospital, Roi Et Province

Abstract

     Research and Development )Research and development) Conduct research according to the conceptual framework of converting knowledge into practice (ACE Star Model) consists of searching for knowledge research synthesis converting synthesizers into action putting knowledge into practice and evaluating The objective is to develop an integrated care system for the dependent elderly by conducting a study of samples in Chaturaphakphiman Hospital During January 2019-Junly 2021, the sample consisted of 30 dependent elderly who met the inclusion and exclusion criteria. Data were collected. by using the daily activities assessment form Barthel ADL index (Barthel Activities of Daily Living : ADL) and data analysis by descriptive statistics.

     Research results: There is an integrated dependent elderly care system consisting of 5 steps: 1) target group search; 2) The attending physician sends a consultant to the care manager for the elderly (Care Manager: CM), 3) CM provides care according to the guideline for providing knowledge about the care of the elderly to relatives or carers. 4) Registration of dependent elderly (Long Term Care) and 5) referral to the continuous care network and 9 integrated guidelines for caring for the elderly with dependent conditions were obtained, including the assessment of daily activities; The Barthel ADL Index (Barthel Activities of Daily Living (ADL) assesses carers. knowledge of patients and relatives knowledge of body care Skills in care and use of equipment supply of equipment Multidisciplinary care before distribution Long-term registration of the elderly Pop up in Hos Xp and Continuing Care Network Data Transmission Thirty dependent elderly people received care according to the integrated care guideline for the dependent elderly. Everyone has been assessed on their daily routines. There was no readmission within 48 hours. The rate of re-hospitalization within 28 days (Re-admitted) was 2 cases. from urinary tract infections and lung infections All patients and relatives were satisfied with their care. After follow-up after discharge from the hospital, 20 elderly patients showed stable symptoms and improved daily activities causing the group to change from being stuck at home 5 cases of bed-bound elderly were socially attached and 5 cases of bed-bound elderly died. easy to follow Takes less time to take care of from 1 hour to 30 minutes and reduces the incidence of operational risks.

     Conclusion : The development of an integrated care system for the dependent elderly enable the elderly to receive care from a multidisciplinary Relatives have the knowledge and skills to take care of them. Including receiving continuous information from the health network, the elderly receive comprehensive and effective care, resulting in a better quality of life for the elderly.