A non-randomised controlled study of the missing link person-centred care transition support intervention after stroke or TIA

TL;DR

A care transition support program improved perceived quality of care after stroke or TIA discharge, enhancing health confidence and literacy.

Contribution

A multicomponent care transition support intervention was tested and shown to improve perceived quality of care transition in stroke/TIA patients.

Findings

The intervention group reported significantly higher perceived quality of care transition compared to controls.

Participants in the intervention group showed greater confidence in managing health and better medication understanding.

Abstract

The transition from hospital to home after stroke or transient ischaemic attack (TIA) is a vulnerable phase marked by gaps in coordination, communication and patient preparedness. This study evaluated the effectiveness of a multicomponent care transition support on perceived quality of care transition (QCT) amongst people with stroke or TIA one week post-discharge. This non-randomised controlled study was conducted in three Swedish hospitals. Adult people with stroke or TIA discharged to home and referred for home-based neurorehabilitation were eligible. Data were collected during hospitalisation and at a blinded one-week follow-up. Primary outcome was perceived QCT, assessed with the Care Transition Measure. Secondary outcomes included health literacy, medication adherence and perception of received care. In total, 163 participants completed follow-up. The intervention group reported higher perceived QCT than controls (p = 0.002), which remained significant after adjustments (β = 6.34; 95% CI 0.56–12.12; p = 0.03). The intervention group reported greater confidence in managing health and better understanding of medications. Health literacy was higher in the intervention group, with no between-group differences in medication adherence or perception of received care. A multicomponent care transition support intervention may improve perceived QCT early after discharge in people with stroke or TIA.

The online version contains supplementary material available at 10.1038/s41598-026-45766-w.

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