Development and effect assessment of transitional care on stroke in communities of Shanghai

Abstract

Objective To explore the development and effects assessment of transitional care on stroke in communities of Shanghai so as to provide a reference for improving the development and assessment of transitional care on stroke. Methods From 30 to 31 October 2018, we selected nurses in 55 communities of Shanghai as subjects by convenience sampling. The self-designed questionnaire was used to investigate the general condition, development program and effects assessment of transitional care on stroke in communities. SPSS 20.0 was used to statistical data analysis. Results Among the 55 communities, 44 (80.0%) communities carried out transitional care on stroke. A total of 29 communities were with the general level of development in transitional care on stroke, and 26 communities were the general level of effects assessment. A total of 41 communities built the linkage model, and only 14 of them had effects assessment indexes. Besides, 93.2% of communities developed two-way referral and telephone follow-up. Conclusions Transitional care on stroke is developed in most communities of Shanghai with limitations in developing program, regional cooperation and effects assessment. The communities need further expand the development program of transitional care on stroke, improve the regional cooperation between hospitals and communities, build effects assessment indexes and pay attention to transitional model and outcome assessment of caregivers. Key words: Stroke; Community health centers; Transitional care; Development; Effect assessment