The Effect of Transitional Care Model-Based Interventions for Stroke Patients and Their Caregivers
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke affects both the patient's and the caregiver's whole life by creating permanent
      damages. Patients and their families need further information and support in the transition
      from hospital to home. For stroke patients and their families after discharge, transition
      models can be used to provide continuously and rapidly the service by establishing a
      communication network between the institutions. In this study, the feasibility and impact of
      a transitional care model from hospital to home for stroke patients and caregivers will be
      tested.

      The purpose of the project is to assess the effect of Transitional Care Model (TCM)-based
      interventions for stroke patients and their caregivers on caregivers' competence, in
      increasing their readiness to care and electronic health literacy, in reducing their burnout,
      and on patient results. Types of interventions that are applied to stroke patients and
      caregivers based on Transitional Care Model are hospital interview, home visit, telephone
      interview and web-based training. As stated in TCM, the intervention was planned to be
      performed three months after discharge.

      Multiple interventions including at least three face-to-face interviews at the hospital,
      distance education via Web and telephone communication for three months, and one home visit
      within seven days after discharge will be performed in order to increase health literacy
      levels and caregiving competence of the caregivers and to reduce burnout. In pre-tests and
      post-tests to be applied to the caregivers, the effectiveness of the support programs
      provided will be assessed quantitatively by the electronic health literacy, caregiving
      competence, and burnout scales. The satisfaction with the intervention will be evaluated
      qualitatively. Rate of return to the hospital, risk of pressure sore, and time of access to
      home health services will be assessed in stroke patients.

      As a result of web-based distance education, home visit, telephone communication service and
      informing at the hospital, caregivers of stroke patients will begin to receive information
      about what patients experience during their treatment and about all what patients need after
      treatment. The website to be prepared for caregivers of stroke patients will be put into
      service also for the control group upon completion of the data collection of the intervention
      group and the website will also continue to be used after the project is completed.
    

Detailed description: 
      Study Protocol

      Minimum three interviews would be carried out in the hospital with the caregivers meeting the
      inclusion criteria after stroke patients are hospitalized.

      The first interview would be carried out within 24-48 hours after the hospitalization.

      The second interview would be carried out on the following day after the first interview.

      The third interview would be carried out two days after the second interview. If required,
      interview would be carried out in the hospital every day.

      The home visit will be realized by the coordination center or researcher within 5 working
      days after discharge.

      Caregivers will be called by the coordinator once at a certain hour every day in the first
      week after discharge and between the second and twelfth weeks. In addition, communication
      with the phone will constantly continue when needed.

      24/7 access to the website, which is prepared for family members / caregivers of stroke
      patients, will be available for three months from discharge.

      The Intervention to be Applied to Control Group

      Preparation of control group for discharge would be made by clinical staff based on routine
      program of the hospital. In the first interview after the admission to the hospital, the
      pretest will be applied to intervention and control groups and the posttest would be applied
      to the groups at the end of three months after discharge. After taking the posttest, the
      website will be made available to the control group.

      Randomization

      Simple randomization method was used in order to randomly select stroke patients and
      caregivers and to assign the intervention and control group impartially. The simple
      randomization method will be used for selecting the caregivers of stroke patients, planned to
      have participated in the study, incidentally from the universe, and for assigning the
      intervention and control group detachedly. Randomization was performed by using the
      https://www.randomizer.org/ website and the intervention and control group were determined
      according to the list obtained. The patients and caregivers will be participated according to
      this sequence number. Pre-tests will be collected by the researcher.

      Data Collection Forms

      It was planned to use separate assessment instruments for the caregivers and the patients.
      Assessment instruments to be used for the caregivers are descriptive information, E-health
      literacy scale, Caregiving Competence Scale, Preparedness for Caregiving Scale, and Maslach
      Burnout Inventory-General Form. Descriptive information, Modified Ranking Scale for
      confinement level, Functional Independence Measure (Küçükdeveci et al., 2001), evaluation of
      rehospitalization of patients, LACE index (length of stay (L), acuity of the admission (A),
      comorbidity of the patient (C) and emergency department use in the duration of 6 months
      before admission (E)) and Braden Scale (Pınar and Oğuz, 1998) for evaluating pressure sores
      were planned to be used as assessment instruments to be used for the patients.
    

Intervention name(s): Transitional care model
Intervention type(s): Other
Intervention description(s): In this study, the feasibility and impact of a transitional care model from hospital to home for stroke patients and caregivers will be tested.
Other intervention name(s): hospital interview; home visit; telephone interview; web-based training
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Types of interventions that are applied to stroke patients and caregivers based on Transitional Care Model are hospital interview, home visit, telephone interview and web-based training.
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Stroke patient; home care; family caregiver; transitional care model; caregiving competence; health literacy; burnout