The results showed that the readmission rates were not statistically significant in the two groups after 2 months, but the rates in the inter-vention group was lower when compared with the control group. This is consistent with the findings of previous studies as per which transi-tional care model is insufficient to control the readmission rates at a significant level (Wong & Yeung, 2015; Zhang et al., 2018). It can be inferred that transitional care interventions can effectively raise the awareness of patients with self-management diseases and help them actively seek medical assistance (Zhao & Wong, 2009). If future stud-ies can be followed up for a longer period of time, it may be possible T A B L E 2 (Continued)
Study (n = 44) Control (n = 44) Total (n = 88) Chi-squared test
n % n % n % χ2 p
Drinking behaviour
Yes 3 6.8 4 9.1 7 8.0 0.291 .865
No 36 81.8 34 77.3 70 79.5
Quit 5 11.4 6 13.6 11 12.5
Note. Values are reported as number and proportions, or mean values and SD. Chi-squared test are applied.
aIndependent t tests are applied since age and duration of disease are treated as continuous variables.
T A B L E 3 ASES-8 results
T1 T2 T3 Between group Within group Interaction effect
Mean (SD) Mean (SD) Mean (SD) F (p) F (p) F (p)
Self-efficacy 1970.077 (<.001) 1479.957 (<.001) 39.752 (<.001)
study 1.94 (1.10) 5.33 (0.82) 6.16 (0.88)
control 2.02 (1.23) 4.57 (0.84) 5.00 (0.81)
t test (p) −0.320 (.750) 4.252 (<.001) 6.413 (<.001)
Note. T1= at baseline; T2= at completion of the 4-week intervention; T3= at 8 weeks after discharge. Independent t tests and repeated-measures ANOVA are applied.
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T A B L E 4 HAQ-DI results
T1 T2 T3 Between group Within group Interaction effect
Mean (SD) Mean (SD) Mean (SD) F (p) F (p) F (p)
Dressing 495.525 (<.001) 193.357 (<.001) 0.330 (.679)
Study 2.18 (0.69) 1.25 (0.78) 0.97 (0.63)
Control 2.18 (0.66) 1.20 (0.77) 1.03 (0.72) t test (p) 0.000 (1.000) 0.276(0.783) −0.403(0.688)
Arising 342.712 (<.001) 140.435(<.001) 5.267 (.010)
Study 1.86 (0.88) 1.11 (0.69) 0.79 (0.59)
Control 1.73 (0.66) 1.07 (0.70) 1.00 (0.70) t test (p) 0.823 (0.413) 0.308 (0.759) −1.569 (0.120)
Eating 557.841 (<.001) 99.392 (<.001) 3.959 (.024)
Study 2.41 (0.73) 1.84 (0.75) 1.38(0.73)
Control 2.39 (0.84) 1.89 (0.97) 1.68 (0.97) t test (p) 0.136 (0.892) −0.247 (0.806) −1.682 (0.096)
Walking 361.621 (<.001) 121.266 (<.001) 2.846 (.065)
Study 2.23 (0.86) 1.52 (0.76) 1.17 (0.82)
Control 2.11 (0.90) 1.57 (0.95) 1.34 (0.98)
t test (p) 0.608 (0.545) −0.248 (0.805) −0.894 (0.374)
Hygiene 535.756 (<.001) 98.199 (<.001) 0.941 (.392)
Study 2.27 (0.79) 1.77 (0.74) 1.40 (0.63)
Control 2.02 (0.76) 1.50 (0.85) 1.28 (0.78)
t test (p) 1.512 (0.134) 1.604 (0.112) 0.821 (0.414)
Reaching 738.285 (<.001) 87.642 (<.001) 2.858 (.060)
Study 2.55 (0.63) 2.14 (0.82) 1.71 (0.66)
Control 2.43 (0.76) 1.84 (0.91) 1.70 (0.87)
t test (p) 0.765 (0.446) 1.593 (0.115) 0.082 (0.935)
Gripping 583.471 (<.001) 86.413 (<.001) 5.245 (.010)
Study 2.16 (0.81) 1.41 (0.69) 1.17 (0.76)
Control 2.05 (0.75) 1.57 (0.63) 1.46 (0.68)
t test (p) 0.687 (0.494) −1.131 (0.261) −1.854 (0.047)
Activities 463.165 (<.001) 87.710 (<.001) 0.129 (.856)
Study 2.20 (0.90) 1.68 (0.80) 1.42 (0.74)
Control 2.16 (0.89) 1.59 (0.82) 1.39 (0.80)
t test (p) 0.238 (0.812) 0.528 (0.599) 0.200 (0.842)
Total 697.757 (<.001) 332.350 (<.001) 5.026 (.013)
Study 2.23 (0.65) 1.59 (0.57) 1.25 (0.54)
Control 2.13 (0.63) 1.53 (0.68) 1.36 (0.67)
t test (p) 0.727 (0.469) 0.465 (0.643) −0.838 (0.404)
Note. T1= at baseline; T2= at completion of the 4-week intervention; T3= at 8 week after discharge. Independent t tests and repeated-measures ANOVA are applied.
T A B L E 5 Comparisons of readmission rates
Study (n = 44) Control (n = 44) Total (n = 88) Chi-squared test
n % n % n % χ2 p
Readmitted 2 4.5 5 11.4 7 8.0 1.397 .237
No readmission 42 95.5 39 88.6 81 92.0
Note.χ2tests are applied.
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to extend the difference in the rate of readmission at a significant level. At the same time, previous studies have also shown that home visits under TCP can effectively reduce the rates of readmission (Jackson et al., 2016), which reminds us that the combination of tele-phone follow-up and home visits may be more beneficial to patients' rehabilitation in the context of transitional care.
4.4 | Limitations
This study suffers from at least four limitations. First, this study was not designed as a double-blind and placebo-controlled trial.
Second, as the study was powered for change in self-efficacy, it was probably underpowered for the readmission rates. Third, this study tested the effect of TCP and tracked it up to 8 weeks after discharge. The long-term effects of the transitional care model could not be ascertained. Fourth, this study only carried out transi-tional care intervention by telephone follow-up. In subsequent studies, we could consider a combination of telephone follow-up and home visits. By doing so, it may be possible to control the readmission rates at a significant level.
5 | C O N C L U S I O N
This study conducts a 4-week Omaha System TCP to promote the self-efficacy to implement disease management, physical function, and health status among patients with RA in mainland China. The effects of this TCP has important implications for the Chinese popula-tion, which encourages them to manage their health at home and rely less on hospitalization, as well as prove the important role of nurses in promoting the rehabilitation of RA patients. This study provides evi-dence for the value of transitional care and facilitate the use and fur-ther testing of this TCP in future multicentre, large-sample transitional care research.
A C K N O W L E D G E M E N T
I would like to thank all participants for their support and coopera-tion in this study. I would also like to express my gratitude to the specialist nurses in the Department of Rheumatology and Immunol-ogy in Xijing Hospital for their contribution to the transitional care interventions. Thanks to the Prof. Hong-Juan Lang for providing general support and guidance to this study. Thanks to my room-mate Ling Guo for her help in finding literature and using literature management software. Finally, I also thank my boyfriend Jia-Hao Ren for his help with my daily life.
C O N F L I C T S O F I N T E R E S T None declared.
F U N D I N G
This study was funded by Shaanxi Province Soft Science Research Project (2015KRM120).
A U T H O R S H I P S T A T E M E N T
Study design: B-HC and Z-CL; data collection: Z-CL, LG and R-RL;
data analysis: LG and W-HZ; manuscript preparation: Z-CL, LG, JW, B-HC, W-HZ and R-RL; Literature Search: JW. All authors have read and approved the final manuscript.
O R C I D
Zhi-Chen Liu https://orcid.org/0000-0001-8093-7001 Bao-Hua Cao https://orcid.org/0000-0002-0141-1413
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How to cite this article: Liu Z-C, Gao L, Zhang W-H, Wang J, Liu R-R, Cao B-H. Effects of a 4-week Omaha System transitional care programme on rheumatoid arthritis patients' self-efficacy, health status, and readmission in mainland China:
A randomized controlled trial. Int J Nurs Pract. 2020;e12817.
https://doi.org/10.1111/ijn.12817
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