Implementation of a billable transitional care model for stroke patients: The COMPASS study

Sabina B. Gesell; Cheryl D. Bushnell; Sara B. Jones; Sylvia W. Coleman; Samantha M. Levy; James G. Xenakis; Barbara J. Lutz; Janet Prvu Bettger; Janet Freburger; Jacqueline R. Halladay; Anna M. Johnson; Anna M. Kucharska-Newton; Laurie H. Mettam; Amy M. Pastva; Matthew A. Psioda; Meghan D. Radman; Wayne D. Rosamond; Mysha E. Sissine; Joanne Halls; Pamela W. Duncan

doi:10.1186/s12913-019-4771-0

Implementation of a billable transitional care model for stroke patients: The COMPASS study

Sabina B. Gesell, Cheryl D. Bushnell, Sara B. Jones, Sylvia W. Coleman, Samantha M. Levy, James G. Xenakis, Barbara J. Lutz, Janet Prvu Bettger, Janet Freburger, Jacqueline R. Halladay, Anna M. Johnson, Anna M. Kucharska-Newton, Laurie H. Mettam, Amy M. Pastva, Matthew A. Psioda, Meghan D. Radman, Wayne D. Rosamond, Mysha E. Sissine, Joanne Halls, Pamela W. Duncan

Epidemiology & Environmental Health

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

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.

Original language	English
Article number	978
Journal	BMC Health Services Research
Volume	19
Issue number	1
DOIs	https://doi.org/10.1186/s12913-019-4771-0
State	Published - Dec 19 2019

Bibliographical note

Publisher Copyright:
© 2019 The Author(s).

Funding

This project received funding from the Wake Forest CTSA through National Center for Advancing Translational Sciences (NCATS) National Institutes of Health (NIH) Grant Award UL1TR001420 and through PCORI Contract Award PCS-1403-14532.

Funders	Funder number
Wake Forest CTSA
National Institutes of Health (NIH)	PCS-1403-14532
National Center for Advancing Translational Sciences (NCATS)	UL1TR001420

Keywords

Implementation Science
Ischemic Attack, Transient
Reimbursement Mechanisms
Stroke
Transitional Care

ASJC Scopus subject areas

Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12913-019-4771-0

Cite this

Gesell, S. B., Bushnell, C. D., Jones, S. B., Coleman, S. W., Levy, S. M., Xenakis, J. G., Lutz, B. J., Bettger, J. P., Freburger, J., Halladay, J. R., Johnson, A. M., Kucharska-Newton, A. M., Mettam, L. H., Pastva, A. M., Psioda, M. A., Radman, M. D., Rosamond, W. D., Sissine, M. E., Halls, J., & Duncan, P. W. (2019). Implementation of a billable transitional care model for stroke patients: The COMPASS study. BMC Health Services Research, 19(1), Article 978. https://doi.org/10.1186/s12913-019-4771-0

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title = "Implementation of a billable transitional care model for stroke patients: The COMPASS study",

abstract = "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.",

keywords = "Implementation Science, Ischemic Attack, Transient, Reimbursement Mechanisms, Stroke, Transitional Care",

author = "Gesell, {Sabina B.} and Bushnell, {Cheryl D.} and Jones, {Sara B.} and Coleman, {Sylvia W.} and Levy, {Samantha M.} and Xenakis, {James G.} and Lutz, {Barbara J.} and Bettger, {Janet Prvu} and Janet Freburger and Halladay, {Jacqueline R.} and Johnson, {Anna M.} and Kucharska-Newton, {Anna M.} and Mettam, {Laurie H.} and Pastva, {Amy M.} and Psioda, {Matthew A.} and Radman, {Meghan D.} and Rosamond, {Wayne D.} and Sissine, {Mysha E.} and Joanne Halls and Duncan, {Pamela W.}",

note = "Publisher Copyright: {\textcopyright} 2019 The Author(s).",

year = "2019",

month = dec,

day = "19",

doi = "10.1186/s12913-019-4771-0",

language = "English",

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Gesell, SB, Bushnell, CD, Jones, SB, Coleman, SW, Levy, SM, Xenakis, JG, Lutz, BJ, Bettger, JP, Freburger, J, Halladay, JR, Johnson, AM, Kucharska-Newton, AM, Mettam, LH, Pastva, AM, Psioda, MA, Radman, MD, Rosamond, WD, Sissine, ME, Halls, J & Duncan, PW 2019, 'Implementation of a billable transitional care model for stroke patients: The COMPASS study', BMC Health Services Research, vol. 19, no. 1, 978. https://doi.org/10.1186/s12913-019-4771-0

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.

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

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Implementation of a billable transitional care model for stroke patients: The COMPASS study

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this