Efectividad de las intervenciones de transición del cuidado hospital-hogar en pacientes con accidente cerebrovascular isquémico

Effectiveness of hospital-to-home care transition interventions in patients with ischemic stroke

  • José-Manuel León Pino Universidad del Bío-Bío, Departamento de Enfermería, Facultad de Ciencias de la Salud y de los Alimentos. Chillán, Chile https://orcid.org/0000-0002-1514-7035
  • Paulina Vargas Chávez Universidad del Bío-Bío, Departamento de Enfermería, Facultad de Ciencias de la Salud y de los Alimentos. Chillán, Chile https://orcid.org/0000-0003-1301-7488
  • Verónica Chandia Reyes Universidad del Bío-Bío, Departamento de Enfermería, Facultad de Ciencias de la Salud y de los Alimentos. Chillán, Chile https://orcid.org/0000-0001-7380-4067
  • Matías Méndez Valdés Universidad del Bío-Bío, Departamento de Enfermería, Facultad de Ciencias de la Salud y de los Alimentos. Chillán, Chile
  • Rosa Castillo Olate Universidad del Bío-Bío, Departamento de Enfermería, Facultad de Ciencias de la Salud y de los Alimentos. Chillán, Chile
  • Madison Tatiana Cid Freire Universidad Santo Tomas, Escuela de Enfermería, Facultad de Salud. Los Ángeles, Chile
DOI: https://doi.org/10.58807/indexenferm20268027
Palabras clave: Accidente cerebrovascular, Cuidado de transición, Alta del paciente, Continuidad de la atención, Enfermería
Key-words: Stroke, Transitional care, Patient discharge, Continuity of patient care, Nursing

Resumen

Abstract

Bibliografía


  1. Feigin VL, Stark BA, Johnson CO, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20(10): 795-820. https://n9.cl/c0j71.

  2. Organización Mundial de la Salud. Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Ginebra: OMS; 2020. https://n9.cl/rp2nl.

  3. Dong C, Gardener H, Rundek T, et al. Factors and Behaviors Related to Successful Transition of Care After Hospitalization for Ischemic Stroke. Stroke. 2022; 54: 468-475. https://www.ahajour nals.org/doi/10.1161/STROKEAHA.122.040891.

  4. Lin S, Xiao L, Chamberlain D, et al. Nurse-led health coaching programme to improve hospital-to-home transitional care for stroke survivors: A randomised controlled trial. Patient Educ Couns. 2021; 104(12): 3004-3012. https://pubmed.ncbi. nlm.nih.gov/34294494/.

  5. Markle-Reid M, Fisher K, Walker K, et al. The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial. BMC Geriatr. 2023; 23(1): 687. https://pubmed.ncbi.nlm.nih. gov/37872479/.

  6. Weiss M, Allen L, Rasmussen J. Impact of a Stroke Transition-of-Care Clinic on 30-Day Readmission Rates. Stroke. 2025; 56(Suppl 1): TP152. https://pubmed.ncbi.nlm.nih.gov/33419903/.

  7. Leonhardt-Caprio A, Sellers C, Palermo E, Caprio T, Holloway R. A Multi-Component Transition of Care Improvement Project to Reduce Hospital Readmissions Following Ischemic Stroke. Neurohospitalist. 2021; 12(2):205-212. https://pub med.ncbi.nlm.nih.gov/35419132/.

  8. Kim K, Jaberizadeh A, Tucker L, et al. A Stroke Case Management Program To Improve Hospital Readmission Rates After Index Stroke. Stroke. 2025; 56(Suppl 1): DP42. https://www.ahajournals. org/doi/10.1161/str.56.suppl_1.DP42.

  9. Duncan P, Bushnell C, Jones S, et al. Randomized Pragmatic Trial of Stroke Transitional Care. Circ Cardiovasc Qual Outcomes. 2020; 13(6): e006285. https://n9.cl/veqbq.

  10. Puhr I, Thompson H. The Use of Transitional Care Models in Patients With Stroke. J Neurosci Nurs. 2015; 47(4): 223–234. https://pubmed.ncbi. nlm.nih.gov/25906245/.

  11. Tan S, Lee S, Rusli K, et al. Effectiveness of Multidisciplinary Transitional Care Interventions on Functional Status, Quality of Life and Readmission Rates in Stroke Patients: A Systematic Review and Meta-Analysis. J Clin Nurs. 2025. https://pub med.ncbi.nlm.nih.gov/40589423/.

  12. O'Callaghan G, Fahy M, Murphy P, et al. Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis. BMC Health Serv Res. 2022; 22(1): 884. https://pubmed.ncbi.nlm.nih.gov/ 36031608/.

  13. Saragih I, Everard G, Saragih I, Lee B. The beneficial effects of transitional care for patients with stroke: A meta-analysis. J Adv Nurs. 2023; 79(11): 4125-4141. https://pubmed.ncbi.nlm.nih. gov/37727124/.

  14. Wong F, Wang S, Ng S, et al. Effects of a transitional home-based care program for stroke survivors in Harbin, China: a randomized controlled trial. Age Ageing. 2022; 51(2): afac027. https://pubmed.ncbi.nlm.nih.gov/35180283/.

  15. Wong F, Yeung S. Effects of a 4-week transitional care programme for discharged stroke survivors in Hong Kong: a randomised controlled trial. Health Soc Care Community. 2015; 23(6): 619-31. https://pubmed.ncbi.nlm.nih.gov/25470529/.

  16. Xu X, Chen H, Xu D, et al. A scoping review of hospital to home transitional care programmes for stroke survivors. J Clin Nurs. 2024. https://pubmed. ncbi.nlm.nih.gov/38887147/.

  17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. https://n9. cl/0a504.

  18. Finlayson K, Chang A, Courtney M, et al. Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults. BMC Health Serv Res. 2018; 18: 956. https://pub med.ncbi.nlm.nih.gov/30541530/.

  19. Tyler N, Hodkinson A, Planner C, et al. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes. JAMA Netw Open. 2023; 6(1): e2344825. https://pubmed.ncbi.nlm.nih.gov/38032 642/.

  20. Rasmussen L, Grode L, Lange J, Barat I, Gregersen M. Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review. BMJ Open. 2021; 11: e040057. https://pubmed.ncbi.nlm.nih.gov/3341 9903/.

  21. Duncan P, Bushnell C, Rosamond W, et al. The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial. BMC Neurol. 2017; 17(1): 133. https://is.gd/MADJPE.

  22. Gesell S, Bushnell C, Jones S, et al. Implementation of a billable transitional care model for stroke patients: the COMPASS study. BMC Health Serv Res. 2019; 19: 978. https://pubmed.ncbi.nlm.nih. gov/31856808/.

  23. Wang Y, Yang F, Shi H, Yang C, Hu H. What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis. Int J Environ Res Public Health. 2017; 14(5): 510. https://pubmed.ncbi.nlm.nih.gov/ 28489044/.

  24. Jee S, Jeong M, Paik N, et al. Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Front Neurol. 2022; 13: 755316. https://pubmed. ncbi.nlm.nih.gov/35370909/.

  25. O'Callaghan G, Fahy M, Murphy P, et al. Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis. BMC Health Serv Res. 2022; 22: 1095. https://pubmed.ncbi.nlm.nih.gov/360 31608/.

  26. Bollinger R, Krauss M, Somerville E, et al. Rehabilitation Transition Program to Improve Community Participation Among Stroke Survivors. JAMA Netw Open. 2024; 7(9): e2437758. https://n9.cl/ib5ua.

  27. Lannin N, Clemson L, Drummond A, et al. Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial. BMJ Open. 2021; 11: e044573. https://pubmed.ncbi.nlm.nih.gov/342 26214/.

  28. Lumprom O, Kritpracha C, Kocakabak C, Latour J. eHealth Technologies in Transitional Care Interventions for Stroke Survivors and Caregivers: A Scoping Review. Florence Nightingale J Nurs. 2025; 33: 274. https://pubmed.ncbi.nlm.nih.gov/ 40698352/.

  29. Termoz A, Delvallée M, Damiolini E, et al. Co-design and evaluation of a patient-centred transition programme for stroke patients, combining case management and access to an internet information platform: study protocol for a randomized controlled trial - NAVISTROKE. BMC Health Serv Res. 2022; 22: 537. https://pubmed.ncbi.nlm. nih.gov/35459183/.

  30. Jiang N, Xv Y, Sun X, et al. Study on self-management of real-time and individualized support in stroke patients based on resilience: a protocol for a randomized controlled trial. Trials. 2023; 24: 493. https://pubmed.ncbi.nlm.nih.gov/3753 7646/.

  31. Michael N, Mselle L, Tarimo E, Cao Y. The Effectiveness of Nurse‐Led Transition Care on Post‐Discharge Outcomes of Adult Stroke Survivors: A Systematic Review and Meta‐Analysis. Nurs Open. 2025; 12(1): e70140. https://pmc.ncbi. nlm.nih.gov/articles/PMC11871394/.

  32. Marini G, Longhini J, Ambrosi E, et al. Transitional Care Interventions in Improving Patient and Caregiver Outcomes After Discharge: A Scoping Review. Healthcare. 2025; 13(3): 312. https://www. mdpi.com/2227-9032/13/3/312.

  33. Fisher MMJB, Marcon SS, Barreto MS, Batista VC, Marquete VF, Souza RR, et al. Caring for a family member with stroke sequelae: the first days at home after hospital discharge. Rev Min Enferm. 2021; 25: e-1385. https://pesquisa.bvsalud.org/ portal/resource/pt/biblio-1340546.

  34. Leite IG, De Domenico EBL, Oliveira VM, Moreira RSL, Teraoka EC. Impact and quality of life on patients affected by cerebral vascular accident. Rev Pesqui Cuid Fundam. 2022; 14: 11583. https://ciberindex.com/index.php/ps/article/view/11 583pcfop.

  35. Souza PB, Mantovani MF, Peres AM, Marcon SS, Madureira AB, Gevert VG. Gestión de casos para personas con accidente cerebrovascular: estudio cuasi-experimental. Cogitare Enferm. 2022; 27: e86989. https://doi.org/10.5380/ce.v27i0.86989.

  36. Sá N, Oliveira F, Almeida F, Sacramento C, Oliveira MI. Rehabilitation nursing program for people with impaired swallowing in the context of stroke: Exploratory study. Rev Port Enferm Reabil. 2023; 6(1): e265. https://rper.aper.pt/index.php/ rper/article/download/265/533/2361.

  37. Conde CIA, Duarte HMS. Using the Delphi technique to validate nursing interventions for stroke patients. Rev Enferm Ref. 2024; 6(1): e23062. https://ciberindex.com/c/ref/e32774rp.

  38. Penagos Suarez SP, Henao-Castaño AM. Comunicación y transferencia del cuidado en el servicio de urgencias. Index de Enfermería 2021; 30(3): 164-168. https://ciberindex.com/c/ie/e12990.

  39. Melita Rodríguez AB, Jara Concha PT, Valencia-Contrera MA. Indicadores de cuidado humanizado de enfermería en atención intrahospitalaria. Index de Enfermería 2022; 31(4): 294-298. https://ciberindex.com/c/ie/e13999.

  40. López Espuela F, González Gil T, Jiménez Gracia MA, Bravo Fernández S, Luengo Morales E, Amarilla Donoso J. ¿Y después del ictus? Reconstrucción de la biografía de pareja. Rev Cient Soc Esp Enferm Neurol. 2013; 38(1): 35-41. https://n9.cl/6tzogp.

  41. Dorado Figueroa CA. Competencia para el cuidado y soporte social percibido en cuidadores de personas con enfermedad cerebrovascular. Cult Cuid. 2022; 19(1): 22-34. https://doi.org/10. 18041/1794-5232/cultrua.2022v19n1.9869.

  42. Silva CR, Costa TF, Pontes ML, Pimenta CJ, Bezerra TA, Ferreira GR, et al. Functionality, stress and quality of life of stroke survivors. Acta Paul Enferm. 2022; 35: eAPE0390345. https://n9.cl/ ia9299.

  43. Sales RS, Moraes MA, Muniz LS, Jesus PA, Ribeiro LS, Mussi FC. Factors associated with functional disability after ischemic stroke. Acta Paul Enferm. 2024; 37: eAPE00601. https://n9.cl/ loh5b.

  44. Cárdenas López MR, Muñoz Torres TJ. Plan de Cuidado Estandarizado en el protocolo de trombólisis por EVCA isquémica: una revisión bibliográfica. Paraninfo Digital. 2025; XIX(40): e40024d. https://ciberindex.com/c/pd/e40024d.

Novedades
Estadísticas
  • Resumen visto - 73 veces
  • PDF descargado - 26 veces
Cómo citar
1.
León Pino, José-Manuel; Vargas Chávez, Paulina; Chandia Reyes, Verónica; Méndez Valdés, Matías; Castillo Olate, Rosa; Cid Freire, Madison Tatiana. Efectividad de las intervenciones de transición del cuidado hospital-hogar en pacientes con accidente cerebrovascular isquémico. Index de Enfermería. 2026; 35(1): e16149. https://doi.org/10.58807/indexenferm20268027 https://ciberindex.com/c/ie/e16149
Número
Año 2026, Vol.35, N.1 [Edición en progreso]
Sección
Revisiones
Comentarios

DEJA TU COMENTARIO     VER 0 COMENTARIOS

Normas y uso de comentarios


Hay un total de 0 comentarios


INTRODUCIR NUEVO COMENTARIO

Para enviar un comentario, rellene los campos situados debajo. Recuerde que es obligatorio indicar un nombre y un email para enviar su comentario (el email no sera visible en el comentario).

Nombre:
 e-mail:
Comentario: