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

• Main Authors: Sabina B. Gesell (Author), Cheryl D. Bushnell (Author), Sara B. Jones (Author), Sylvia W. Coleman (Author), Samantha M. Levy (Author), James G. Xenakis (Author), Barbara J. Lutz (Author), Janet Prvu Bettger (Author), Janet Freburger (Author), Jacqueline R. Halladay (Author), Anna M. Johnson (Author), Anna M. Kucharska-Newton (Author), Laurie H. Mettam (Author), Amy M. Pastva (Author), Matthew A. Psioda (Author), Meghan D. Radman (Author), Wayne D. Rosamond (Author), Mysha E. Sissine (Author), Joanne Halls (Author), Pamela W. Duncan (Author)
• Format: Book
• Published: BMC, 2019-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1186/s12913-019-4771-0; 1472-6963
• Keywords: Implementation Science; Stroke; Ischemic Attack, Transient; Transitional Care; Reimbursement Mechanisms; Public aspects of medicine; RA1-1270
• Source: BMC Health Services Research, Vol 19, Iss 1, Pp 1-14 (2019)

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.