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

Publication ,  Journal Article
Gesell, SB; Bushnell, CD; Jones, SB; Coleman, SW; Levy, SM; Xenakis, JG; Lutz, BJ; Bettger, JP; Freburger, J; Halladay, JR; Johnson, AM ...
Published in: BMC Health Serv Res
December 19, 2019

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.

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Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

December 19, 2019

Volume

19

Issue

1

Start / End Page

978

Location

England

Related Subject Headings

  • Transitional Care
  • Telephone
  • Subacute Care
  • Stroke
  • Postal Service
  • Patient Discharge
  • North Carolina
  • Middle Aged
  • Male
  • Ischemic Attack, Transient
 

Citation

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Gesell, S. B., Bushnell, C. D., Jones, S. B., Coleman, S. W., Levy, S. M., Xenakis, J. G., … Duncan, P. W. (2019). Implementation of a billable transitional care model for stroke patients: the COMPASS study. BMC Health Serv Res, 19(1), 978. https://doi.org/10.1186/s12913-019-4771-0
Gesell, Sabina B., Cheryl D. Bushnell, Sara B. Jones, Sylvia W. Coleman, Samantha M. Levy, James G. Xenakis, Barbara J. Lutz, et al. “Implementation of a billable transitional care model for stroke patients: the COMPASS study.BMC Health Serv Res 19, no. 1 (December 19, 2019): 978. https://doi.org/10.1186/s12913-019-4771-0.
Gesell SB, Bushnell CD, Jones SB, Coleman SW, Levy SM, Xenakis JG, et al. Implementation of a billable transitional care model for stroke patients: the COMPASS study. BMC Health Serv Res. 2019 Dec 19;19(1):978.
Gesell, Sabina B., et al. “Implementation of a billable transitional care model for stroke patients: the COMPASS study.BMC Health Serv Res, vol. 19, no. 1, Dec. 2019, p. 978. Pubmed, doi:10.1186/s12913-019-4771-0.
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. Implementation of a billable transitional care model for stroke patients: the COMPASS study. BMC Health Serv Res. 2019 Dec 19;19(1):978.
Journal cover image

Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

December 19, 2019

Volume

19

Issue

1

Start / End Page

978

Location

England

Related Subject Headings

  • Transitional Care
  • Telephone
  • Subacute Care
  • Stroke
  • Postal Service
  • Patient Discharge
  • North Carolina
  • Middle Aged
  • Male
  • Ischemic Attack, Transient