| Multidisciplinary transmural programme | Usual care |
---|---|---|
Care content | ||
Multidisciplinary stroke team | + | + |
Care based on Dutch stroke guidelines | + | + |
Tailored approach with Goal Attainment Scaling | + | - |
Self-management | + | - |
Stroke education | + | - |
Home therapy during nursing home admission | + | - |
Multidisciplinary outpatient rehabilitation | + | - |
Home visits of transmural stroke care coordinator | + | - |
Care organisation | ||
Transmural stroke care coordinator | + | - |
Multidisciplinary team meetings in nursing home | + | + |
Multidisciplinary team meetings after discharge | + | - |
Electronic transmural patient record | + | - |