Construction Of Transitional Care Model Of Downward Referral For Stroke Patients In Regional Medical Alliance

BackgroundWith the rapid development of China’s economy and significant improvement of medical security,there are more and more stroke survivors.In the promotion of the medical policy of early discharge,it is more urgent to provide transitional care from hospital to home for them.Through the establishment of medical alliance,medical institutions at all levels develop in the mode of clear division of labor,mutual cooperation and resource information sharing,which is the current national medical environment.In the context of medical conditions,many scholars provided transitional care for stroke patients through the downward referral platform of the regional medical alliance.However,most of them is an interventional original study,reported in a way to explore its application effect.At present,the schemes constructed in these studies are not perfect and lack of support based on evidence-based medicine or related theories.Objective1.To explore the downward referral experiences of stroke caregivers in the regional medical alliance,in order to provide content basis for the construction of transitional care model of downward referral.2.To construct the transitional care model of downward referral for stroke patients in regional medical alliance.Methods1.Semi-structured interview:A purposive sampling strategy was used to select 13 stroke caregivers who were in the Department of Neurology of a hospital from April to July 2021.All of them experienced downward referral from the regional medical alliance from the high-level hospital to the low-level hospital.The descriptive phenomenological approach was applied,and the contents were analyzed using Colaizzi 7-step analysis.2.Literature research:In the first part,we mainly searched the intervention studies of providing transitional care for stroke patients by using the downward referral platform of medical alliance,so as to provide reference for the dimension content of the transitional care model;In the second part,we expanded the search scope and supplemented the search of the clinical decision,guidelines,evidence summaries,best practice,recommended practice,clinical practice and expert consensuses of transitional care for stroke patients in domestic and foreign databases,so as to provide reference for the contents of the transitional care model.3.Delphi technique:From May to June 2022,18 experts from 12 tertiary hospitals and 3 universities were invited to participate in expert consultation.Revising and improving the contents of the items according to the experts’suggestions,so as to form a standardized,complete and scientific final version of the transitional care model.Results1.Semi-structured interviews:The analysis of the data revealed four themes and eleven sub-themes.The four themes were(1)coping challenges;(2)disrupted information;(3)gaps in medical and nursing transition,and(4)potential enabling factors.This part showed that stroke caregivers had poor experiences and more needs to be met after downward referral.At the same time,the following suggestions were provided for the construction of transitional care model:(1)Knowledge training of medical alliance/Hierarchical Medical System;(2)Medical workers take the initiative to introduce medical alliance/Hierarchical Medical System;(3)Establish an information sharing platform;(4)Determine the criteria for downward referral;(5)Nurse professional training;(6)Continuous attention after downward referral.2.Literature research:part one:116 literatures were initially retrieved,and 4 RCTS and 2 experimental studies were eventually included,providing 4 dimensions of implementation institutions,personnel allocation,key links and implementation paths for the construction of transitional care model.Part two:1756 literatures were initially retrieved,and 1 clinical decision-making,6 guidelines,2 standards,and 5 evidence summaries were eventually included,providing 30 pieces of evidence for the construction of transitional care model.3.Delphi technique:2 rounds of expert consultations were carried out,the effective recovery rates were 100%and 94.4%respectively.The two rounds of expert authority coefficients were 0.867 and 0.868 respectively.The Kendall harmony coefficients were 0.118 and 0.267,respectively(P<0.01).The coefficient of variation of each item in the second round was 0～0.204.The finalized transitional care model of downward referral included 5 dimensions(implementing institutions,personnel allocation,key links,implementation paths and effect evaluation),23 primary items and 60 secondary items.ConclusionBased on qualitative study,literature research and Delphi expert consultation,this study constructed a transitional care model of downward referral for stroke patients in the regional medical alliance.The formulation process of this model was rigorous and standardized,with certain scientificity and reliability,complete content,and strong extrapolation of clinical practice,which could provide reference for providing transitional care services for stroke survivors in regional medical alliance.