基于“恰当时机”框架为接受气道支架置入患者制定分阶段出院计划：一项德尔菲研究

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中文摘要

目的： 本研究旨在为接受气道支架置入的气道狭窄患者制定动态、分阶段的出院计划干预措施并优化护理路径，以弥补术后并发症管理和家庭护理能力方面的不足。
方法： 以“恰当时机”（Timing It Right, TIR）为理论基础，通过整合文献综述、对7名医生、9名护士和8名患者的半结构化访谈以及专家组讨论制定初始方案。随后通过三轮迭代德尔菲专家咨询进行完善。根据汇总反馈进行修订以最终确定方案。
结果： 完成了三轮专家咨询，问卷通过电子邮件和微信发放。各轮应答率分别为95.24%、100%和100%。专家权威系数（Cr）全程超过0.7；变异系数范围分别为0.05至0.17、0.06至0.23和0.06至0.19；Kendall's W值分别为0.172、0.166和0.187（p < 0.001）。最终出院计划包括5个主要领域：诊断阶段（入院至术前）、稳定阶段（术后至稳定恢复）、准备阶段（出院前3天）、实施阶段（出院后至1个月）、适应阶段（出院后1-3个月），以及15个二级类别和57个三级条目。经过三轮修订后，所有57个三级指标均满足重要性均分>4.00且变异系数<0.25的保留标准。
结论： 以“恰当时机”框架构建的出院计划干预措施具有科学严谨性和操作可行性，为患者支架置入后的护理提供了标准化且全面的路线图。未来研究需要进行前瞻性临床试验，以量化其对并发症发生率、非计划再入院和患者生活质量的影响。

英文摘要

OBJECTIVE: This study aimed to develop a dynamic, phased discharge planning intervention and optimize the nursing care pathway for patients with airway stenosis undergoing airway stenting, to address gaps in complication management and home care competencies following the procedure.
METHODS: Employing the Timing It Right (TIR) as a theoretical basis, the initial program was developed through integrated literature review, semi-structured interviews with 7 physicians, 9 nurses and 8 patients, and expert panel group discussions. Subsequent refinement involved three iterative rounds of Delphi consultation with domain experts. Revisions were made based on aggregated feedback to finalize the program.
RESULTS: Three rounds of expert consultation were completed, with questionnaires distributed via email and WeChat. Response rates were 95.24, 100, and 100% across the respective rounds. The expert authority coefficient (Cr) exceeded 0.7 throughout; coefficient of variation ranged from 0.05 to 0.17, 0.06 to 0.23, and 0.06 to 0.19; Kendall's W values were 0.172, 0.166, and 0.187, respectively (p < 0.001). The final discharge plan comprised 5 primary domains: diagnosis phase (admission to pre-surgery), stabilization phase (postoperative to stable recovery), preparation phase (3 days pre-discharge), implementation phase (post-discharge to 1 month), adaptation phase (1-3 months post-discharge), plus 15 secondary categories and 57 tertiary items. All 57 tertiary indicators satisfied the retention criteria of mean importance score >4.00 and coefficient of variation <0.25 after three rounds of revision.
CONCLUSION: The discharge planning intervention, structured around the Timing It Right Framework, demonstrates scientific rigor and operational feasibility, offering a standardized and comprehensive roadmap for the post-stenting care of patients. Prospective clinical trials are required in future research to quantify its effects on complication incidence, unplanned readmission and patient quality of life.