TY - JOUR
T1 - Implementation of a billable transitional care model for stroke patients
T2 - The COMPASS study
AU - Gesell, Sabina B.
AU - Bushnell, Cheryl D.
AU - Jones, Sara B.
AU - Coleman, Sylvia W.
AU - Levy, Samantha M.
AU - Xenakis, James G.
AU - Lutz, Barbara J.
AU - Bettger, Janet Prvu
AU - Freburger, Janet
AU - Halladay, Jacqueline R.
AU - Johnson, Anna M.
AU - Kucharska-Newton, Anna M.
AU - Mettam, Laurie H.
AU - Pastva, Amy M.
AU - Psioda, Matthew A.
AU - Radman, Meghan D.
AU - Rosamond, Wayne D.
AU - Sissine, Mysha E.
AU - Halls, Joanne
AU - Duncan, Pamela W.
N1 - Publisher Copyright:
© 2019 The Author(s).
PY - 2019/12/19
Y1 - 2019/12/19
N2 - Background: The COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic trial compared the effectiveness of comprehensive transitional care (COMPASS-TC) versus usual care among stroke and transient ischemic attack (TIA) patients discharged home from North Carolina hospitals. We evaluated implementation of COMPASS-TC in 20 hospitals randomized to the intervention using the RE-AIM framework. Methods: We evaluated hospital-level Adoption of COMPASS-TC; patient Reach (meeting transitional care management requirements of timely telephone and face-to-face follow-up); Implementation using hospital quality measures (concurrent enrollment, two-day telephone follow-up, 14-day clinic visit scheduling); and hospital-level sustainability (Maintenance). Effectiveness compared 90-day physical function (Stroke Impact Scale-16), between patients receiving COMPASS-TC versus not. Associations between hospital and patient characteristics with Implementation and Reach measures were estimated with mixed logistic regression models. Results: Adoption: Of 95 eligible hospitals, 41 (43%) participated in the trial. Of the 20 hospitals randomized to the intervention, 19 (95%) initiated COMPASS-TC. Reach: A total of 24% (656/2751) of patients enrolled received a billable TC intervention, ranging from 6 to 66% across hospitals. Implementation: Of eligible patients enrolled, 75.9% received two-day calls (or two attempts) and 77.5% were scheduled/offered clinic visits. Most completed visits (78% of 975) occurred within 14 days. Effectiveness: Physical function was better among patients who attended a 14-day visit versus those who did not (adjusted mean difference: 3.84, 95% CI 1.42-6.27, p = 0.002). Maintenance: Of the 19 adopting hospitals, 14 (74%) sustained COMPASS-TC. Conclusions: COMPASS-TC implementation varied widely. The greatest challenge was reaching patients because of system difficulties maintaining consistent delivery of follow-up visits and patient preferences to pursue alternate post-acute care. Receiving COMPASS-TC was associated with better functional status. Trial registration: ClinicalTrials.gov number: NCT02588664. Registered 28 October 2015.
AB - Background: The COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic trial compared the effectiveness of comprehensive transitional care (COMPASS-TC) versus usual care among stroke and transient ischemic attack (TIA) patients discharged home from North Carolina hospitals. We evaluated implementation of COMPASS-TC in 20 hospitals randomized to the intervention using the RE-AIM framework. Methods: We evaluated hospital-level Adoption of COMPASS-TC; patient Reach (meeting transitional care management requirements of timely telephone and face-to-face follow-up); Implementation using hospital quality measures (concurrent enrollment, two-day telephone follow-up, 14-day clinic visit scheduling); and hospital-level sustainability (Maintenance). Effectiveness compared 90-day physical function (Stroke Impact Scale-16), between patients receiving COMPASS-TC versus not. Associations between hospital and patient characteristics with Implementation and Reach measures were estimated with mixed logistic regression models. Results: Adoption: Of 95 eligible hospitals, 41 (43%) participated in the trial. Of the 20 hospitals randomized to the intervention, 19 (95%) initiated COMPASS-TC. Reach: A total of 24% (656/2751) of patients enrolled received a billable TC intervention, ranging from 6 to 66% across hospitals. Implementation: Of eligible patients enrolled, 75.9% received two-day calls (or two attempts) and 77.5% were scheduled/offered clinic visits. Most completed visits (78% of 975) occurred within 14 days. Effectiveness: Physical function was better among patients who attended a 14-day visit versus those who did not (adjusted mean difference: 3.84, 95% CI 1.42-6.27, p = 0.002). Maintenance: Of the 19 adopting hospitals, 14 (74%) sustained COMPASS-TC. Conclusions: COMPASS-TC implementation varied widely. The greatest challenge was reaching patients because of system difficulties maintaining consistent delivery of follow-up visits and patient preferences to pursue alternate post-acute care. Receiving COMPASS-TC was associated with better functional status. Trial registration: ClinicalTrials.gov number: NCT02588664. Registered 28 October 2015.
KW - Implementation Science
KW - Ischemic Attack, Transient
KW - Reimbursement Mechanisms
KW - Stroke
KW - Transitional Care
UR - http://www.scopus.com/inward/record.url?scp=85076993015&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076993015&partnerID=8YFLogxK
U2 - 10.1186/s12913-019-4771-0
DO - 10.1186/s12913-019-4771-0
M3 - Article
C2 - 31856808
AN - SCOPUS:85076993015
SN - 1472-6963
VL - 19
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 978
ER -
