Development of a case management model for breast cancer patients undergoing MRM surgery, Sakon Nakhon Hospital

การพัฒนารูปแบบการจัดการรายกรณีในผู้ป่วยมะเร็งเต้านมที่ได้รับการผ่าตัดแบบเอ็มอาร์เอ็ม โรงพยาบาลสกลนคร

Abstract

This research is research and development, the objective was to analyze situational management, to develop and to evaluate of a case management model for patients after MRM breast cancer surgery at Sakon Nakhon Hospital. The sample group consists of 1) The main informants are divided into 3 groups which purposive sampling from a multidisciplinary team as follows: administrators, practitioners with at least 5 years of experience and patients. 2) The assessors of the suitability of the created model were divided into 4 groups of 15 people, including 1 expert, 4 administrator, 5 practitioners, and a group of breast cancer patients who received treatment with MRM surgery for 5 people, selected purposive  from 5 patients, with the operations being from October 2020 – April 2021. Research in 3 phases: situation analysis phase, Case management model development phase, and the trial and evaluation model for breast cancer patients undergoing MRM surgery. Data were collected using discussion topics using the aesthetics discussion process with a group of key informants. Data were analyzed using descriptive statistics. Data are presented as percentages, averages of the appropriateness assessment scores for each item in each dimension. The research results found that

1. Case management model for breast cancer patients undergoing MRM surgery in the Sakon Nahkon hospital that elements of the model include: 1) structural aspects Policy is set Clear goals and assignments There are operational standards. 2) Process aspect is a case management model put into practice and continuous follow-up. 3) Outcomes of service recipients. Receive quality service that meets the needs and satisfaction of service recipients.
2. Assessing the appropriateness of the case management model for breast cancer patients undergoing MRM surgery at Sakon Nakhon Hospital, found 2.1) It was appropriate for use with an average of 92 % and the appropriateness classified by aspect was found. Independent dimension of model development It has the highest appropriateness score of 95.2 % in terms of clarity and presentation. It has the lowest appropriateness score, 88.8 %. 2.2) Results of following the developed model found that Breast cancer patients had an increase in their knowledge score of 83.33%, with no incidence of complications after surgery. Overall patient satisfaction was at a high level of 84.32% and average sleep days Before the development of average sleep days of 11 days/case and after the development of average sleep days of 10 days/case, sleep days decreased by 1 day. In terms of treatment costs Before development, the average cost was 36,000 baht/person and after development. Average expenses 35,000 baht/person. Expenses reduced by 1,000 baht/person.

            Suggestions: The results of the study indicate that it is necessary to consider the needs and suitability of the agency and hospital context.