According to the Department of Health (1997), the hospitalization rate is positively correlated with the age. Currently, the hospitalization rate of people aged 65 or older is three times that of people aged under 65 years old and the cost of hospitalization for people age 65 and older was around 33 % of the total cost for hospitalization. In addition, elderly patients are at high risk for physical deterioration during post-hospital recovery and suffer frequent early readmission. The responsibility of caring for the post-discharge elderly creates strain and a burden for their family caregivers. Effective discharge planning programs are critical to meet the post-hospital needs of the high-risk hospitalized elderly persons and their family caregivers. However, current studies in the western countries on the effectiveness of discharge planning have inconsistent findings and most of them do not base on a theoretical framework. Furthermore, a lack of studies on the discharge planning using comparison group in Taiwan is found. Therefore, current study intends to fill the gap of knowledge by using a randomized clinical trail to explore the cost-effectiveness of a nurse-directed discharge-planning program that will be developed based on culturally relevant theoretical concepts.

      In this three-year project, a discharge-planning program will be developed in the first year based on PI’s previous related studies. This discharge-planning program will be nurse-directed, include both in-hospital and post-discharge components, and will be designed to enhance caregiver’s competence, felt balance between competing needs, and discharge needs satisfaction. During the first year, the discharge-planning program will be developed and a pilot study will be conducted in the neurological wards of Chang Gung Memorial Hospital (CGMH) in Lin Kuo. The pilot study will have 10 high-risk hospitalized elderly patients and their family caregivers in experimental and 10 in control group to test the feasibility of the discharge-planning program, establish the reference for sample size modification, and develop training manual and a tape for research nurses in this project. Formal study will be conducted in the second and third year. In the formal study, a clinical trial will be conducted to examine the cost-effectiveness of the developed discharge-planning program. In order to increase the generalizability of the results, both medical centers and district hospitals will be included in the study. High-risk elderly patients with neurological diseases from two district hospitals in southern Taiwan and one medical center in northern Taiwan will be included. Subjects from each hospital will be randomly assigned to experimental and control groups. Subjects in the experimental group will receive regular hospital routine care and the developed discharge-planning program. Subjects in the control group will receive only regular hospital routine care. The outcome variables of this study will include both direct and indirect outcomes. The indirect outcomes consist of caregiver competence, need satisfaction, and felt balance between competing needs. Indirect outcomes include caregiving consequences, caregiving pattenalization, caregiver and elderly patient’s quality of life, service utilization and the cost of care. These outcome variables will be followed for 6 months after hospital discharge and compared between the experimental and control group. A qualitative component to explain the impact of this discharge planning program on the organization behavior changes of the clinical study sites will be conducted at the third year. Findings of this study can contribute to the current nursing knowledge and practice for providing care to high-risk hospitalized elderly patients and their family caregivers during discharge transition.