Implementation of Discharge Planning Based on Patient Centered Care for Post Stroke Patients in the Stroke Unit: A Systematic Review
Abstract
Background: Stroke is a major mortality factor necessitating coordinated care systems to prevent incidents and enhance patient prognosis. The implementation of discharge planning based on patient centered care in stroke patients aims to increase patient involvement through the provision of personalized information and shared decision making, in order to prepare patients for daily activities after discharge from the hospital. This study aims to Assess the effectiveness and impact of implementing patient-centered care-based discharge planning after stroke on patient satisfaction, quality of life, and reduction in hospital re-visits.
Methods: The authors conducted a systematic review using PRISMA 2020 Guidelines. The article were derived from four electronic databases (Web of Science, JStor, PubMed, and Scopus) using keywords and terms relevant to the research topic. Consisting of full text original research articles published between 2019 and 2025 using quantitative and qualitative methods.
Results: A total of 2,518 records were identified. Nine articles met the selection inclusion criteria were included due to having good methodological quality Patient-centered discharge planning interventions were associated with improved quality of life, patient satisfaction, adherence to post-discharge plans, and reduced hospital readmissions.
Conclusion: Patient-centered discharge planning models positively influence patient satisfaction, quality of life, and rehospitalization rates among post-stroke patients. Implementing structured, multidisciplinary discharge planning protocols based on patient-centered care principles is crucial to improving stroke recovery outcomes.
References
1. Lindblom S, Flink M, von Koch L, Laska AC, Ytterberg C. Feasibility, Fidelity and Acceptability of a Person-Centred Care Transition Support Intervention for Stroke Survivors: A Non-Randomised Controlled Study. Health Expect Int J Public Particip Health Care Health Policy. 2024;27(5):e70057. doi:10.1111/hex.70057
2. Yousufuddin M, Young N. Aging ang Stroke. Aging. 2019;11(9):2542-2544.
3. Kurniati N, Nursalam N, Kartini Y. The Effect Of Discharge Planning Combines Audiovisual With The Family Centered Nursing Preparedness Caring For Acute Post Stroke Patients. Interest J Ilmu Kesehat. 2022;10(2):154-165. doi:10.37341/interest.v0i0.345
4. Prick JCM, Engelhardt EG, Lansink Rotgerink FK, et al. Implementation of a patient decision aid for discharge planning of hospitalized patients with stroke: aprocess evaluation using a mixed-methods approach. Patient Educ Couns. 2025;136. doi:10.1016/j.pec.2025.108716
5. Dіachuk DD, Moroz GZ, Hidzynska IM, Kravchenko AM. IMPLEMENTATION OF PATIENT-CENTERED CARE AND MEDICAL CARE IMPROVEMENT: CURRENT STATE (REVIEW). Clin Prev Med. 2023;1(23):67-77. doi:10.31612/2616-4868.1(23).2023.10
6. Gray J, Lyerly M. Discharge Planning. 2024. doi:10.1007/978-3-031-66289-8_32
7. Omonaiye O, Ward-Stockham K, Darzins P, et al. Hospital discharge processes: Insights from patients, caregivers, and staff in an Australian healthcare setting. PLoS ONE. 2024;19(9 September):1-15. doi:10.1371/journal.pone.0308042
8. Li J, Zhang H, Gao Y, et al. Application of Hospital-Community-Family “Trinity” Remote Rehabilitation Guidance Based on Internet + WeChat Platform in Patients with Stroke After Discharge. Altern Ther Health Med. 2024;30(1):358-365.
9. Rahayu CD, Purnamasari I, Alviana F, Wibowo DA, Amir H. Analysis of structured discharge planning implementation for discharged inpatients: a multicenter study. Healthc Low-Resour Settings. 2025;13(1):42-46. doi:10.4081/hls.2024.13192
10. Wulandari DF, Hariyati R. 70 PILOT STUDY Wulandari et al. IJNHS. Int J Nurs Health Serv IJNHS. 2019;2(1):70-81.
11. Heryyanoor H, Diana H, Melinda Restu P, Asih Dwi M. Nurses’ perceptions of discharge planning implementation: A descriptive qualitative study. J Plb Nurs Stud. 2024;3(2):68-79. doi:10.55048/jpns126
12. Muhammad Imron Rosadi Mujib, Fitri Arofiati. Development of Discharge Planning for Stroke Patients. Folia Medica Indones. 2023;59(4):396-405. doi:10.20473/fmi.v59i4.42819
13. Ingram L, Pitt R, Shrubsole K. Health professionals’ practices and perspectives of post-stroke coordinated discharge planning: a national survey. Brain Impair. 2024;25(1):1-14. doi:10.1071/IB23092
14. Veronese M, Vellone E, Alvaro R, Pucciarelli G. The transitional care from hospital to home for stroke survivors and their caregivers: A systematic review. J Vasc Nurs. 2025;43(2):86-98. doi:10.1016/j.jvn.2025.03.002
15. Wong EL, Yam CH, Cheung AW, et al. Barriers to effective discharge planning: A qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Serv Res. 2011;11. doi:10.1186/1472-6963-11-242
16. Lewis M. Evidence-Based Best Practice for Discharge Planning: A Policy Review. Univ St Augustine Health Sci. Published online 2022.
17. Parry C, Johnston-Fleece M, Johnson MC, Shifreen A, Clauser SB. Patient-Centered Approaches to Transitional Care Research and Implementation: Overview and Insights from Patient-Centered Outcomes Research Institute’s Transitional Care Portfolio. Med Care. 2021;59(3 S):S330-S335. doi:10.1097/MLR.0000000000001593
18. Page MJ, McKenzie JE, Bossuyt P, et al. The prisma 2020 statement: An updated guideline for reporting systematic reviews. Med Flum. 2021;57(4):444-465. doi:10.21860/medflum2021_264903
19. Barker TH, Habibi N, Aromataris E, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evid Synth. 2024;22(3):378-388. doi:10.11124/JBIES-23-00268
20. Oley MH, Oley MC, Kepel BJ, et al. Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A Systematic Review and Meta-analysis. Plast Reconstr Surg - Glob Open. 2024;12(3):e5692. doi:10.1097/GOX.0000000000005692
21. Oley MH, Oley MC, Sukarno V, Faruk M. Advances in Three-Dimensional Printing for Craniomaxillofacial Trauma Reconstruction: A Systematic Review. J Craniofac Surg. 2024;35(7):1926-1933. doi:10.1097/SCS.0000000000010451
22. Krishnan S, Hay CC, Pappadis MR, Deutsch A, Reistetter TA. Stroke Survivors’ Perspectives on Post-Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home. J Neurol Phys Ther. 2019;43(3):160-167. doi:10.1097/NPT.0000000000000281
23. Halladay J, Bushnell C, Psioda M, et al. Patient Factors Associated With Attendance at a Comprehensive Postacute Stroke Visit: Insight From the Vanguard Site. Arch Rehabil Res Clin Transl. 2020;2(1). doi:10.1016/j.arrct.2019.100037
24. Flink M, Lindblom S, Tistad M, et al. Person-centred care transitions for people with stroke: Study protocol for a feasibility evaluation of codesigned care transition support. BMJ Open. 2021;11(12). doi:10.1136/bmjopen-2020-047329
25. Lateef MA, Mhlongo EM. A qualitative study on patient-centered care and perceptions of nurses regarding primary healthcare facilities in Nigeria. Cost Eff Resour Alloc. 2022;20(1). doi:10.1186/s12962-022-00375-y
26. Lin S, Wang C, Wang Q, et al. The experience of stroke survivors and caregivers during hospital-to-home transitional care: A qualitative longitudinal study. Int J Nurs Stud. 2022;130:104213. doi:10.1016/j.ijnurstu.2022.104213
27. Po HW, Lin FJ, Cheng HJ, et al. Factors Affecting the Effectiveness of Discharge Planning Implementation: A Case-Control Cohort Study. J Nurs Res. 2023;31(3):E274. doi:10.1097/jnr.0000000000000555
28. Siskaningrum A, Yusuf A, Mahmudah, Machin A. Nurse Performance and Influence Factors in Discharge Planning Based on Knowledge Management SECI Model in Stroke Patients. J Med Chem Sci. 2023;6(10):2558-2568. doi:10.26655/JMCHEMSCI.2023.10.30
29. Xiao Y, Xu X. Enhanced stroke rehabilitation outcomes through Information-Motivation-Behavioral skills model and Hospital-Community-Family ternary linkage integration: A randomized controlled trial. Med U S. 2025;104(9):e41547. doi:10.1097/MD.0000000000041547
30. Lindblom S, Flink M, von Koch L, et al. A person-centred care transition support for people with stroke/TIA: A study protocol for effect and process evaluation using a non-randomised controlled design. PLoS ONE. 2024;19(3 March). doi:10.1371/journal.pone.0299800
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Halimatus Sa’diyah, Mira Triharini, Ilya Krisnana, Novia Caecilia Laoli, Nurma Lindawati
This work is licensed under a Creative Commons Attribution 4.0 International License.
