Introduction
Methods
Study design
1. Can you tell me about your hospitalisation first? Why are you here? |
2. How long after you were admitted to the hospital did someone tell you that you might need to continue treatment and rehabilitation elsewhere after being discharged? |
3. Do you or your family know where you can receive post-acute care and rehabilitation after discharge? (Inpatient rehabilitation hospital, skilled nursing facility, home health, and outpatient rehabilitation)? Where did you get this information? Has anyone discussed it with you? |
4. Why did you accept/reject post-acute care? |
5. Which post-acute care model did you choose? Why? What factors did you consider? |
Study subjects and recruitment
Data collection
Data analysis
Results
Respondent characteristics
NO | Age (years) | Gender | Admission MRS† | Discharged MRS | Educational level | Main caregiver | Hospital location and level | Stroke type | Onset of stroke (weeks)‡ |
---|---|---|---|---|---|---|---|---|---|
1 | 61 | Male | 3 | 2 | University | Spouse | Northern Academic medical center | Ischemic | 13 |
2 | 76 | Female | 3 | 3 | Elementary school | Child | Northern Academic medical center | Ischemic | 6 |
3 | 60 | Male | 4 | 3 | Elementary school | Spouse | Northern Academic medical center | Ischemic | 2 |
4 | 62 | Female | 2 | 2 | Senior high school | Spouse | Northern Academic medical center | Ischemic | 15 |
5 | 55 | Male | 2 | 2 | Senior high school | Spouse | Northern Academic medical center | Hemorrhage | 10 |
6 | 52 | Male | 2 | 2 | University | Spouse | Northern Academic medical center | Ischemic | 2 |
7 | 55 | Female | 3 | 3 | Senior high school | Spouse | Northern Academic medical center | Ischemic | 3 |
8 | 78 | Male | 4 | 3 | Elementary school | Child | Northern Academic medical center | Ischemic | 20 |
9 | 62 | Female | 3 | 3 | Senior high school | Spouse | Northern Academic medical center | Ischemic | 11 |
10 | 83 | Female | 3 | 2 | No formal education | Child | Northern Academic medical center | Ischemic | 2 |
11 | 33 | Female | 3 | 4 | University | Parents | Northern Academic medical center | Ischemic | 11 |
12 | 80 | Male | 4 | 3 | No formal education | Spouse | Northern Academic medical center | Ischemic | 6 |
13 | 92 | Male | 4 | 2 | No formal education | Child | Northern Academic medical center | Ischemic | 11 |
14 | 76 | Male | 3 | 4 | No formal education | Foreign care worker | Northern Regional Teaching | Ischemic | 7 |
15 | 49 | Male | 4 | 3 | Senior high school | Spouse | Northern Regional Teaching | Ischemic | 23 |
16 | 75 | Female | 4 | 3 | Elementary school | Child | Central Regional Teaching | Ischemic | 3 |
17 | 75 | Male | 3 | 3 | Junior high school | Family | Southern Academic medical center | Ischemic | 12 |
18 | 57 | Male | 4 | 3 | Senior high school | Spouse | Southern Academic medical center | Ischemic | 10 |
19 | 81 | Female | 5 | 4 | No formal education | Child | Southern Academic medical center | Ischemic | 7 |
20 | 57 | Male | 2 | 2 | Senior high school | Spouse | Southern Academic medical center | Ischemic | 6 |
21 | 59 | Male | 2 | 2 | Junior high school | Spouse | Southern Academic medical center | Ischemic | 16 |
Theme
Meaning unit | Condensed meaning unit |
---|---|
The doctor said that I had a nerve injury, so they put pressure on my brain first. Then after about three days, when there was no bleeding, they arranged rehabilitation for me to see how far I could go. So, I was scheduled to undergo rehabilitation in the hospital. As they were all known members of the medical team, I accepted the doctor’s advice. I was in hospital for probably about a week. (N05) | They would arrange rehabilitation for me… So, rehabilitation was arranged in the hospital. I was in hospital for probably about a week. (a1-1) |
We followed the doctor’s advice and stayed in the hospital for treatment and rehabilitation. The rehabilitation programme included functional therapy, speech therapy, and acupuncture. So, we stayed in the hospital for three months. We hope to receive complete rehabilitation in order to have a smooth recovery. (N06) | We followed the doctor’s advice and stayed in the same hospital for treatment and rehabilitation…… We stayed in the hospital for three months. (a1-1) |
At about the third month of hospitalisation, they suggested that I go to another hospital or clinic for rehabilitation. (N09) | At the third month of hospitalisation… I was advised to go to other hospitals or clinics for rehabilitation. (a1-1) |
At that time, the stroke doctor helped me consult a physiatrist. But the physiatrist said that rehabilitation would not be effective for me, so I did not continue rehabilitation. (N11) | The physiatrist said that rehabilitation would not be effective, so I did not receive rehabilitation. (a1-2) |
Because I have had 3–4 strokes, the doctor suggested maintaining the status quo. However, when I had a stroke before, the doctor suggested that I go to the rehabilitation centre in Xinzhuang for rehabilitation. (N02) | I have had 3–4 strokes… The doctor suggested maintaining the status quo. However, when I had a stroke before, the doctor suggested that I go to the rehabilitation centre in Xinzhuang for rehabilitation. (a1-2) |
When we were preparing to be discharged from the hospital, the nurse gave us a form with information on rehabilitation medical institutions for our reference, and we made choices based on the list of rehabilitation hospitals in that form. (N04) | The nurse gave us a form with information on rehabilitation medical institutions for our reference, and we made choices based on the list of rehabilitation hospitals in that form. (a2-1) |
Before I was discharged, the hospital gave me a piece of paper with information about rehabilitation hospitals for reference, and I also searched the Internet for rehabilitation hospitals near my home… I am currently on rehabilitation at a clinic near my home. At that time, the doctor told me that I could come back to the original treatment hospital for outpatient rehabilitation, but it was too far. I wanted to rehabilitate at the clinic near us. It would be more convenient for me to be closer to home. So, I discussed it with the doctor. (N04) | The hospital gave me a piece of paper with information about rehabilitation hospitals for reference… I also searched the Internet for rehabilitation hospitals near my home… The doctor told me that I could come back to the original treatment hospital for outpatient rehabilitation, but it was too far. Rehabilitation at the clinic near us would be more convenient for me. (b1-1) |
After staying for more than ten days, we considered going to the Miners’ Hospital as it was closer to our home because he needed to be on rehabilitation for a long time. If he received rehabilitation in the hospital in Keelung… the distance would be inconvenient. So, we discussed with the doctor saying that we wanted to go to the Miners’ Hospital for rehabilitation. (N15) | Because he needed to be on rehabilitation for a long time, the Miners’ Hospital was seen as more convenient as it was closer to our home. If he received rehabilitation in the hospital in Keelung…the distance would be inconvenient. (b1-1) |
The hospital actually suggested that we go to a nearby hospital, but we did not have enough people to take care of him. He could not take care of himself, having trouble urinating and eating, so I had to apply for resources for foreign workers and long-term care. (N08) | The hospital actually suggested that we go to a nearby hospital… but we did not have enough people to take care of him… He could not take care of himself, having trouble urinating and eating, so I had to apply for resources for foreign workers and long-term care. (b2-1) |
He cannot receive any treatment at the moment, because we siblings have to go to work. Only our mother can help take care of him… The doctor actually suggested that we go to a nearby hospital for rehabilitation, but we lacked the manpower to take care of him…. So, we applied for long-term care and foreign nursing care. (N10) | He cannot receive any treatment at the moment, because we siblings have to go to work. Only our mother can help take care of him… The doctor actually suggested that we go to a nearby hospital for rehabilitation, but we could not take care of him…. So, we applied for long-term care and foreign nursing care. (b2-1) |
I was scheduled to undergo rehabilitation in the hospital. As they were all known members of the medical team, I accepted the doctor’s advice. I was in hospital for probably about a week. (N05) | As they were all known members of the medical team, I accepted the doctor’s advice. (c1-1) |
we stayed in the hospital for three months. We hope to receive complete rehabilitation in order to have a smooth recovery. (N06) | We hope to receive complete rehabilitation in order to have a smooth recovery. (c1-2) |
My husband was afraid that no one would urge me to exercise when I was at home… If I participated in the PAC rehabilitation programme, there would be specialised stroke physicians, physiatrists, rehabilitation therapists, and ward nurses to assist me in rehabilitation. The nurse would also guide me to do some stretching exercises on the hospital bed, etc… If I transferred to another hospital for rehabilitation, I would worry about whether the coordination would be as smooth. During inpatient rehabilitation, I also saw some patients who were more serious than me. But after working hard on rehabilitation, some of them recovered very well and could walk on their own. (N09) | In the PAC rehabilitation programme I participated in, there were specialised stroke physicians, physiatrists, rehabilitation therapists, and ward nurses to assist me in rehabilitation. The nurse would also guide me to do some stretching exercises on the hospital bed, etc… If I transferred to another hospital for rehabilitation, I would worry about whether the coordination would be as smooth. (c1-3) |
When he had his first stroke, he went back to the hospital for rehabilitation, which lasted for more than ten years. But ever since the urinary catheter was placed, he did not like to walk outside or go to the hospital. So, no rehabilitation was arranged for him when he had a stroke this time. (N14) | When he had his first stroke, he was on rehabilitation for more than ten years… But ever since the urinary catheter was placed, he did not like to walk outside or go to the hospital. So, no rehabilitation was arranged for him. (d1-1) |
We went to a clinic near our home for rehabilitation earlier. But because she was afraid of pain, she stopped going after a while. The main reason was that she was not proactive. Later, she developed backache, so she did not want to go even more and became even more resistant. As she did not like it, we did not want to force her. (N10) | We went to a clinic near our home for rehabilitation earlier. But because she was afraid of pain, she stopped going after a while… The main reason was the negative attitude. Later, she developed backache, so she did not want to go even more and became even more resistant…(d1-2) |
The doctor told us that after being discharged from the hospital, we could choose to go to a medical institution or take care of him at home. We wanted to take him home and take care of her, but in reality, we could not do so because she still required suctioning of the thick phlegm and had to rely on oxygen after being discharged from the hospital. No one dared to pump the phlegm out, so we had to let him go to a nursing home first. (N19) | The doctor said that after being discharged from the hospital, we could choose to go to a medical institution or take care of him at home. We wanted to take her home and take care of him, but in reality, we could not do so because she had to rely on oxygen when she was discharged from the hospital. No one dared to pump the phlegm out, so we had to let her go to a nursing home first. (d2-1) |
It was not long after I was hospitalised, I went to Taipei Wanhua Hospital for hyperbaric oxygen therapy at the suggestion of a friend. (N01) | Received hyperbaric oxygen therapy in Taipei Wanhua Hospital at the suggestion of a friend. (d3-1) |
This was my first stroke. I stayed in hospital for about two weeks, and one week after I was hospitalised, a rehabilitator came to the ward for rehabilitation and helped with stretching exercises of the hands and feet. After I was discharged from the hospital, I chose the current rehabilitation hospital mainly because of the environment, equipment, and recommendations from friends. (N16) | After I was discharged from the hospital, I chose the current rehabilitation hospital mainly because of the environment, equipment, and recommendations from friends. (d3-1) |
We have chosen home care for several years. Somebody would come to our home to help with stretching exercises every day. Every month, home care would send a doctor to our home or give us a call to check on dad’s condition. Is there any need to increase or decrease rehabilitation measures?… We would also discuss with the doctors in the hospital… We felt that home care was very good. So, when the hospital wanted to assist us in applying for home care, we agreed. (N03) | We have chosen home care for several years… Somebody would come to our home to help with stretching exercises every day…….We felt that home care was very good. So, when the hospital wanted to assist us in applying for home care, we agreed. (d4-1) |
Everyone has to go to work on weekdays. It is more convenient for us to choose home care, and the burden is lighter than that of foreign care. (N03) | Everyone has to go to work on weekdays. It is more convenient for us to choose home care, and the burden is lighter than that of foreign care. (e1-1) |
In addition to choosing the kind of care that was the best for him, what was also important was that the cost of care should be affordable for us. During hospitalisation earlier, we hired a Taiwanese care worker for NT$ 2,000 a day. We stayed in the hospital for more than ten days and spent more than NT$ 30,000. (N08) | In addition to choosing the kind of care that was the best for him, what was also important was that the cost of care should be affordable for us. (e1-1) |
Advice of medical professionals
“When we were preparing to be discharged from the hospital, the nurse gave us a form with information on rehabilitation medical institutions for our reference, and we made choices based on the list of rehabilitation hospitals in that form.” (N04).The doctor said that I had a nerve injury, so they put pressure on my brain first. Then after about three days, when there was no bleeding, they arranged rehabilitation for me to see how far I could go. So, I was scheduled to undergo rehabilitation in the hospital. I was in hospital for probably about a week. (N05)“We followed the doctor’s advice and stayed in the hospital for treatment and rehabilitation. The rehabilitation programme included functional therapy, speech therapy, and acupuncture. So, we stayed in the hospital for three months.” (N06).“At that time, the stroke doctor helped me consult a physiatrist. But the physiatrist said that rehabilitation would not be effective for me, so I did not continue rehabilitation.” (N11).
Accessibility of health care resources
Before I was discharged from the hospital, the hospital gave me a piece of paper with information about rehabilitation hospitals for reference, and I also searched the Internet for rehabilitation hospitals near my home… I am currently on rehabilitation at a clinic near my home. At that time, the doctor told me that I could come back to the original treatment hospital for outpatient rehabilitation. I wanted to rehabilitate at a clinic near us. It would be more convenient for me to be closer to home. So, I discussed it with the doctor. (NO4)After staying for about ten days, we considered going to the Miners’ Hospital as it was closer to our home because he needs to be on rehabilitation for a long time. If he receives rehabilitation in the hospital in Keelung… the distance would be inconvenient. So, we discussed with the doctor saying that we wanted to go to the Miners’ Hospital for rehabilitation. (N15)
The hospital actually suggested that we go to a nearby hospital, but we could not take care of him. He could not take care of himself, having trouble urinating and eating, so I had to apply for resources for foreign workers and long-term care. (N08)He cannot receive any treatment at the moment, because we siblings have to go to work. Only our mother can help take care of him, but my mom is not in very good health now. The doctor actually suggested that we go to a nearby hospital for rehabilitation, but we lack the manpower to take care of him…. So, we applied for long-term care and foreign nursing care, which made it more convenient for us to go to work. It was also easier on our mom. Only after we adapt to the foreign nursing care will we take our father to the hospital for rehabilitation. (NO10)
Continuity and coordination of care
I was scheduled to undergo rehabilitation in the hospital. As they were all known members of the medical team, I accepted the doctor’s advice. I was in hospital for probably about a week. (N05)we stayed in the hospital for three months. We hope to receive complete rehabilitation in order to have a smooth recovery. (N06)If I participated in the PAC rehabilitation programme, there would be specialised stroke physicians, physiatrists, rehabilitation therapists, and ward nurses to assist me in rehabilitation. The nurse would also guide me to do some stretching exercises on the hospital bed, etc… If I transfer to another hospital for rehabilitation, I will worry whether the coordination will be as smooth. During the inpatient rehabilitation, I also saw some patients who were more serious than me. But after working hard on rehabilitation, some of them recovered very well and could walk on their own. (NO9)
Willingness and past experience of patients and their relatives and friends
We went to a clinic near our home for rehabilitation earlier. But she stopped going after a while because she was afraid of pain. The main reason was that she was not proactive. Later, she developed backache, so she did not want to go even more and became even more resistant. As she did not like it, we did not want to force her. (N10)When he had his first stroke, he went back to the hospital for rehabilitation, which lasted for more than ten years. But ever since the urinary catheter was placed, he did not like to walk outside or go to the hospital. So, no rehabilitation was arranged for him when he had a stroke this time. (N14)The doctor told us that after being discharged from the hospital, we could choose to go to a medical institution or take care of her at home. We wanted to take her home and take care of him, but in reality, we could not do so because she still required suctioning of the thick phlegm and had to rely on oxygen after being discharged from the hospital. No one dared to pump the phlegm out, so we had to let him go to a nursing home first. (N19)
“It was not long after I was hospitalised, I went to Taipei Wanhua Hospital for hyperbaric oxygen therapy at the suggestion of a friend.” (N01).This was my first stroke. I stayed in hospital for about two weeks. One week after I was hospitalised, a rehabilitator came to the ward for rehabilitation and helped with stretching exercises of the hands and feet. After I was discharged from the hospital, I chose the current rehabilitation hospital mainly because of the environment, equipment, and recommendations from friends. (N16)We have chosen home care for several years. Somebody would come to our home to help with stretching exercises every day. Every month, home care would send a doctor to our home or give us a call to check on dad’s condition. Is there any need to increase or decrease rehabilitation measures? We would also discuss with the doctors in the hospital… We felt that home care was very good. So, when the hospital wanted to assist us in applying for home care, we agreed. (N03)
Economic factors
“Everyone has to go to work on weekdays. It is more convenient for us to choose home care, and the burden is lighter than that of foreign nursing care.” (N03).In addition to choosing the kind of care that was the best for him, what was also important was that the cost of care should be affordable for us. During hospitalisation earlier, we hired a Taiwanese care worker for NT$ 2,000 a day. We stayed in the hospital for more than ten days and spent more than NT$ 30,000. (N08)