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Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial.

Publication ,  Journal Article
Bushnell, CD; Kucharska-Newton, AM; Jones, SB; Psioda, MA; Johnson, AM; Daras, LC; Halladay, JR; Prvu Bettger, J; Freburger, JK; Gesell, SB ...
Published in: J Am Heart Assoc
December 7, 2021

Background Mortality and hospital readmission rates may reflect the quality of acute and postacute stroke care. Our aim was to investigate if, compared with usual care (UC), the COMPASS-TC (Comprehensive Post-Acute Stroke Services Transitional Care) intervention (INV) resulted in lower all-cause and stroke-specific readmissions and mortality among patients with minor stroke and transient ischemic attack discharged from 40 diverse North Carolina hospitals from 2016 to 2018. Methods and Results Using Medicare fee-for-service claims linked with COMPASS cluster-randomized trial data, we performed intention-to-treat analyses for 30-day, 90-day, and 1-year unplanned all-cause and stroke-specific readmissions and all-cause mortality between INV and UC groups, with 90-day unplanned all-cause readmissions as the primary outcome. Effect estimates were determined via mixed logistic or Cox proportional hazards regression models adjusted for age, sex, race, stroke severity, stroke diagnosis, and documented history of stroke. The final analysis cohort included 1069 INV and 1193 UC patients (median age 74 years, 80% White, 52% women, 40% with transient ischemic attack) with median length of hospital stay of 2 days. The risk of unplanned all-cause readmission was similar between INV versus UC at 30 (9.9% versus 8.7%) and 90 days (19.9% versus 18.9%), respectively. No significant differences between randomization groups were seen in 1-year all-cause readmissions, stroke-specific readmissions, or mortality. Conclusions In this pragmatic trial of patients with complex minor stroke/transient ischemic attack, there was no difference in the risk of readmission or mortality with COMPASS-TC relative to UC. Our study could not conclusively determine the reason for the lack of effectiveness of the INV. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

December 7, 2021

Volume

10

Issue

23

Start / End Page

e023394

Location

England

Related Subject Headings

  • United States
  • Stroke
  • Patient Readmission
  • Medicare
  • Male
  • Ischemic Attack, Transient
  • Humans
  • Female
  • Fee-for-Service Plans
  • Aged
 

Citation

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Chicago
ICMJE
MLA
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Bushnell, C. D., Kucharska-Newton, A. M., Jones, S. B., Psioda, M. A., Johnson, A. M., Daras, L. C., … Duncan, P. W. (2021). Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial. J Am Heart Assoc, 10(23), e023394. https://doi.org/10.1161/JAHA.121.023394
Bushnell, Cheryl D., Anna M. Kucharska-Newton, Sara B. Jones, Matthew A. Psioda, Anna M. Johnson, Laurie C. Daras, Jacqueline R. Halladay, et al. “Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial.J Am Heart Assoc 10, no. 23 (December 7, 2021): e023394. https://doi.org/10.1161/JAHA.121.023394.
Bushnell CD, Kucharska-Newton AM, Jones SB, Psioda MA, Johnson AM, Daras LC, et al. Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial. J Am Heart Assoc. 2021 Dec 7;10(23):e023394.
Bushnell, Cheryl D., et al. “Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial.J Am Heart Assoc, vol. 10, no. 23, Dec. 2021, p. e023394. Pubmed, doi:10.1161/JAHA.121.023394.
Bushnell CD, Kucharska-Newton AM, Jones SB, Psioda MA, Johnson AM, Daras LC, Halladay JR, Prvu Bettger J, Freburger JK, Gesell SB, Coleman SW, Sissine ME, Wen F, Hunt GP, Rosamond WD, Duncan PW. Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial. J Am Heart Assoc. 2021 Dec 7;10(23):e023394.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

December 7, 2021

Volume

10

Issue

23

Start / End Page

e023394

Location

England

Related Subject Headings

  • United States
  • Stroke
  • Patient Readmission
  • Medicare
  • Male
  • Ischemic Attack, Transient
  • Humans
  • Female
  • Fee-for-Service Plans
  • Aged