Research participants were recruited from the Affiliated Hospital of Zunyi Medical University between January 2021 and October 2021. A researcher contacted eligible patients and those who met the inclusion criteria at the time of admission and provided written informed consent were enrolled. The inclusion criteria were (1) age $\ge$18 years; (2) diagnosis based on the diagnostic criteria of AD in “Braunwald Cardiology” [16], in which a diagnosis of type B AD was based on clinical manifestations, cardiac ultrasound, and computed tomography angiography; (3) ability to use WeChat; (4) provision of written informed consent. The exclusion criteria were (1) the presence of cognitive or psychiatric problems, (2) transfer to another medical facility, and (3) inability to use emails. All protocols were performed in accordance with relevant guidelines and regulations.

The sample size was calculated using the formula shown in Eqn. 1 [17], as previously described [18].

(1)$$n1=n2=2{\left[\left(u_{\alpha }+u_{\beta }\right)/(\delta /\sigma )\right]}^2+0.25u{\alpha }^2$$

where $u_{\alpha }=1.96;u_{\beta }=1.282;\delta /\sigma =0.85;$ and $n1=n2=30$.

The calculated sample size was 60. Allowing for a 20% dropout rate, each group comprised 36 individuals. The patients were randomly divided into intervention and control groups using the random number table method. The specific randomized scheme was as follows: (1) numbering: 72 patients were numbered according to the order of admission; (2) generating random numbers: 72 random numbers (repeated numbers skipped) were successively selected from the second row and first column of the random number table as patient numbers, and then the random numbers were ranked successively in ascending order; (3) random grouping: the rank of the random numbers was 1–36 for the intervention group and 37–72 for the control group.

The intervention group received the 5As model-based transitional nursing care, created by the research group through expert meetings based on literature analysis and the development of relevant standards. The program’s draft was reviewed by nine experts (four cardiovascular specialists, four cardiovascular nursing specialists, and one chronic illness management specialist). Experts were invited if they met the following criteria: (1) at least 10 years of relevant work experience and (2) possessed a doctorate degree or held a prominent professional position. Based on their suggestions, the program was modified and improved. Table 1 presents the final transitional care program.

In the control group, the participants received normal care in accordance with hospital guidelines. Routine nursing care after admission was performed, as well as general evaluation, general hospital propaganda, such as the environment department personnel arrangements within the department, family visitation rules during the coronavirus disease 2019 outbreak, and education. During hospitalization, patients and caregivers were informed about the purpose of the inspection and time according to the division within the conventional nursing program. The patients were introduced to AD-related knowledge, purpose, function, and key points regarding various treatments. When discharged, the patients and caregivers were guided to undergo the discharge procedures. They were also informed about relevant rehabilitation knowledge, including the type of medicine, treatment record, post-discharge medications, diet, and exercise suggestions. Finally, the importance of timely follow-up visits was emphasized.

Several strategies were adopted to ensure intervention fidelity. First, participants were instructed to strictly adhere to the project’s research procedures and training provided by planned implementers in the department meeting room through lectures that impart scientific knowledge and skills. The scientific expertise includes diet, exercise, and blood pressure management; skill learning involves the 5As consulting method, which helps the medical staff to complete the five consulting steps in a short period: (1) assessment of the preoperative cardiovascular risk behavior of the patients with AD; (2) making suggestions according to the risk behaviors of the patients; (3) reaching an agreement concerning the goals and action plans by making joint decisions with the patients and their families; (4) assisting patients in solving their obstacles in the implementation of health plans; (5) arranging follow-up visits according to the actual situation of the patients, guiding them to follow-up within the specified time. Second, we standardized the management of patient education and telephone follow-up projects, established a self-management health manual for patients with AD, and established systematic telephone follow-up records. Third, a checklist for the intervention was created, and each item was checked upon completion. Fourth, the study group met once a week to discuss the status of the study and assess whether the interventions were administered as planned.

Discharge readiness level and transitional care quality were assessed using the appropriate instruments and tools. We conducted a preliminary experiment with 20 patients with AD before the main study to test the feasibility of the study methodology and establish the reliability of the scale.

A trained nurse collected baseline data from the patients upon admission, evaluated the discharge readiness scale on the day of discharge, and collected the transitional care quality scale scores on the 30th day after discharge.

Data were analyzed using SPSS WIN (version 18.0, IBM Corp., Armonk, NY, USA). General categorical data, such as sex, marital status, medical insurance type, education level, and occupation, are presented as frequencies and percentages and were analyzed using the chi-square test or Fisher’s exact probability method. Age, length of hospital stay, hospitalization expenses, and other metric data are presented as the mean, standard deviation, or quartile and were analyzed using the independent samples t-test or rank-sum test. The discharge readiness and transitional care quality scores of the two groups are described as the median and interquartile interval or the mean and standard deviation. The differences in the transitional care quality scores between the two groups were analyzed using a two-sample independent t-test or rank-sum test. The selected inspection level of the statistical results was $\alpha$ = 0.05, and a p-value 0.05 indicated statistical significance.

In the 201 pairs of screened participants, 55 patients were ineligible, and 74 patients declined to participate. A total of 72 pairs of eligible participants agreed to participate in this study and were randomly assigned to the intervention group (n = 36) or the control group (n = 36). During the research period, two patients in the control group were lost on the 30th day after discharge, with a follow-up rate of 5.56%. In the intervention and the control groups, 36 and 34 patients completed this research, respectively. The comprehensive standard flowchart of this research is shown in Fig. 1.

Fig. 1.

Study flowchart.

Table 2 shows the characteristics of the participants in the two groups. There were no remarkable differences in the characteristics of the participants in the intervention and control groups, except for the length of hospital stay (p $>$ 0.05).

The results presented in Table 3 show that the intervention group had remarkably higher values than the control group in terms of personal status, coping ability, expected support, and total RHDS scores (p 0.05).

Table 4 shows the scores for critical understanding, importance of preference, management preparation, existence of a written and understandable care plan, and total score of transitional nursing care quality, all of which were significantly higher in the intervention group than in the control group (p 0.05).

TEVAR has gained popularity owing to the advancement of medical technology, with a decrease in the average length of hospital stay, a reduction in the time to prepare for discharge, and prevention of inadequate preparation for discharge. Improving discharge preparation is one of the most effective measures against EHR [23]. Our findings showed that the 5As model-based transitional care program improved the discharge readiness of patients with type B AD, consistent with Xu et al. [24] and Peyrovi et al. [25]. The effectiveness of our findings can be attributed to several factors. First, based on the new definition of admission as preparation for discharge, early and timely assessment of AD risk factors and rapid discharge preparation-related interventions following admission provide patients with more time to prepare for hospital discharge and are associated with better outcomes [26]. Second, individualized and targeted health behavior recommendations were provided to the patients during hospitalization, and post-discharge health behavior goals were set according to the patient’s priorities. Ha Dinh et al. [27] showed that targeted interventions can encourage participants to receive more valuable information. Throughout the intervention, caregivers were encouraged to work with the patients to set discharge rehabilitation goals and strengthen their social support. Another important finding of our study was that the length of hospital stay was significantly shorter in the intervention group than in the control group. This may be related to our transition plan, including preoperative and early postoperative rehabilitation recommendations.

The patient’s perspective is key to determining the quality of referral management. The Medical Research Institute emphasizes the need to evaluate the quality of transitional care from the patient’s perspective [28]. Therefore, our study used the CTM-15 to assess patients’ perceptions of the quality of transitional care. Our results suggest that scientifically designed transitional care plans can improve the quality of transitional care for patients with type B AD, consistent with earlier research findings [29, 30]. The success of this transitional care plan lies in filling the gap in the transition from hospital to home. The 5As model is an evidence-based intervention strategy that includes health education, coaching, counseling, and psychosocial support. Although there is no consensus on the composition of transitional care post-TEVAR, the participation of patients and medical staff is important. Intervention measures may include discharge planning, patient and family education, follow-up care, rehabilitation, and information exchange between nursing providers [31, 32]. Moreover, study has shown that trust-based relationships between patients and nurses can be established and maintained using appropriate methods with advanced nursing knowledge and skills [33]. Similarly, those conducting the interventions in this study received training through lectures on scientific knowledge and skills. Accordingly, patients could actively and accurately seek external help when faced with environmental changes and adverse stimuli to achieve the best adaptation state.

In addition, in our study, on the 90th day after discharge, the proportion of patients in the intervention group with controlled blood pressure at the recommended level (100–120/60–80 mmHg) was 75%, which was higher than in the control group (58.9%). These findings are similar to those reported by Carroll et al. [34]. Our previous study showed that although most patients administered their medication regularly, nearly 67.2% did not achieve a controlled blood pressure at the recommended level. Most patients were unaware of other blood pressure control methods besides the use of antihypertensive drugs, and many did not master the correct technique and timing of blood pressure measurement, leading to a deviation in blood pressure records; this may be one of the reasons for hospital readmissions [9]. In our study, patients were also trained in non-drug blood pressure control methods and blood pressure measurement skills. We invited pharmacists to participate, and the 5As were used to create a patient-centered model for counseling patients regarding blood pressure to increase the frequency of visits for those with poorly controlled hypertension.

One of the strengths of our study is that we considered poor blood pressure control in patients with type B AD. After discharge, pharmacists helped patients adjust their medication to control their blood pressure levels. Another advantage is interdisciplinary cooperation, which helps identify risk factors associated with a patient’s previous lifestyle early.

However, our study has a limitation. We could not measure the impact of the transitional care program on readmission and mortality rates. A larger sample size and longer follow-up period are needed to evaluate the effects of transitional care plans on readmission rates and mortality.