Implementation of a billable transitional care model for stroke patients: the COMPASS study.
BMC Health Serv Res
; 19(1): 978, 2019 Dec 19.
Article
em En
| MEDLINE
| ID: mdl-31856808
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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ataque Isquêmico Transitório
/
Acidente Vascular Cerebral
/
Cuidado Transicional
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Sysrev_observational_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article