Affordability and Efficiency for COMprehensive Post-Acute Stroke Services (COMPASS )

  • Kucharska-Newton, Anna (PI)

Grants and Contracts Details


Stroke is the fourth-leading cause of death in the US and a major cause of long-term disability. Stroke is also expensive to treat; stroke-attributable medical costs in the US are projected to triple from $71.6 billion in 2012 to $184.1 billion in 2030. Both patients and caregivers have identified a significant lack of a seamless, integrated continuum of care as a major obstacle to navigating post-acute care. This has resulted in inconsistent delivery of stroke care, especially to patients discharged to home, who in NC constitute approximately 50% of all stroke patients. Stroke care can be improved through alternative payment models that emphasize transitions from acute to post-acute care. Our team’s COMprehensive Post- Acute Stroke Services (COMPASS) model of care, which combines transitional care and early supported discharge services, is being implemented in a pragmatic cluster randomized trial of 41 NC hospitals. The trial will determine if this model of care improves patient-centered functional outcomes, reduces caregiver strain, and reduces readmissions for all stroke patients discharged directly home. Data for COMPASS participants will be linked with healthcare claims from Medicare, Medicaid and a large private insurer, enabling estimates of care expenditures for study participants. The effect of COMPASS on readmissions will likely be the key incentive for healthcare systems to adopt and sustain such evidence regarding post-acute services. The overall goal of this study is to analyze the business case for both payers and hospital systems for the post-acute services for stroke included in COMPASS. These outcomes have not been assessed previously in a randomized control trial. The specific aims in support of study goals are: (1) to estimate the incremental cost of implementing the COMPASS model to key stakeholders, including participating hospitals, payers, and patients; (2) to estimate the incremental change in 90-day payments for stroke patient care attributed to COMPASS for Medicare, Medicaid, and a large private insurer; and (3) to estimate the return on investment of COMPASS to hospitals and payers under alternative payment models (e.g., current fee-for-service vs. stroke “bundle”). We will use a mix of secondary data sources and key informant interviews in an activity-based costing approach to measure the incremental resource cost of implementing COMPASS. Additionally, we will leverage administrative healthcare claims linked with COMPASS data to obtain cost of care information. This study will contribute evidence of interventions that can achieve lower cost without sacrificing quality of care and inform the design of a stroke “bundle” that ensures hospitals and payers benefit.
Effective start/end date8/1/1811/15/22


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