The Impact of Hospital-Community-Home Collaborative Continuum of Care on Cognitive Function and Caregiver Burden in Stroke Patients with Cognitive Impairment

Abstract

To investigate the effects of integrated hospital-community-home continuity of care on cognitive function and caregiver burden in stroke patients with cognitive impairment, a total of 104 patients with post-stroke cognitive impairment (PSCI) who were hospitalized in the Department of Neurology at a Grade A Level III general hospital (the top tier hospital in China) in Sichuan Province between October 2024 and October 2025 were enrolled in the study. Using a random number table, they were divided into a control group (n=52) and an intervention group (n=52), where the control group received conventional post-discharge care, while the intervention group received “hospital-community-home” three-tier collaborative post-discharge care. The effects of the two care interventions on patients’ cognitive function, caregiver stress, and patients’ activities of daily living were then compared. Results showed that there were no significant difference in MoCA scores, in CBI scores between the caregivers of patients and in MBI scores in the two groups at discharge (P > 0.05); however, at 3 months and 6 months post-discharge, the MoCA scores, the CBI scores, and the MBI scores of patients in the intervention group were all significantly higher than those in the control group (P < 0.05). In conclusion, “hospital-community-home” integrated continuity of care could effectively improve cognitive ability and self-care capacity in stroke patients with cognitive impairment and reduce caregiver burden, making it worthy of clinical implementation for patients’ sake.