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Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial.

Publication ,  Journal Article
Freburger, JK; Pastva, AM; Coleman, SW; Peter, KM; Kucharska-Newton, AM; Johnson, AM; Psioda, MA; Duncan, PW; Bushnell, CD; Rosamond, WD ...
Published in: Arch Phys Med Rehabil
May 2022

OBJECTIVES: To examine the effect of a comprehensive transitional care model on the use of skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care in the 12 months after acute care discharge home following stroke; and to identify predictors of experiencing a SNF or IRF admission following discharge home after stroke. DESIGN: Cluster randomized pragmatic trial SETTING: Forty-one acute care hospitals in North Carolina. PARTICIPANTS: 2262 Medicare fee-for-service beneficiaries with transient ischemic attack or stroke discharged home. The sample was 80.3% White and 52.1% female, with a mean (SD) age of 74.9 (10.2) years and a mean ± SD National Institutes of Health stroke scale score of 2.3 (3.7). INTERVENTION: Comprehensive transitional care model (COMPASS-TC), which consisted of a 2-day follow-up phone call from the postacute care coordinator and 14-day in-person visit with the postacute care coordinator and advanced practice provider. MAIN OUTCOME MEASURES: Time to first SNF or IRF and SNF or IRF admission (yes/no) in the 12 months following discharge home. All analyses utilized multivariable mixed models including a hospital-specific random effect to account for the non-independence of measures within hospital. Intent to treat analyses using Cox proportional hazards regression assessed the effect of COMPASS-TC on time to SNF/IRF admission. Logistic regression was used to identify clinical and non-clinical predictors of SNF/IRF admission. RESULTS: Only 34% of patients in the intervention arm received COMPASS-TC per protocol. COMPASS-TC was not associated with a reduced hazard of a SNF/ IRF admission in the 12 months post-discharge (hazard ratio, 1.20, with a range of 0.95-1.52) compared to usual care. This estimate was robust to additional covariate adjustment (hazard ratio, 1.23) (0.93-1.64). Both clinical and non-clinical factors (ie, insurance, geography) were predictors of SNF/IRF use. CONCLUSIONS: COMPASS-TC was not consistently incorporated into real-world clinical practice. The use of a comprehensive transitional care model for patients discharged home after stroke was not associated with SNF or IRF admissions in a 12-month follow-up period. Non-clinical factors predictive of SNF/IRF use suggest potential issues with access to this type of care.

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Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

May 2022

Volume

103

Issue

5

Start / End Page

882 / 890.e2

Location

United States

Related Subject Headings

  • United States
  • Stroke Rehabilitation
  • Stroke
  • Skilled Nursing Facilities
  • Rehabilitation Centers
  • Rehabilitation
  • Patient Discharge
  • Medicare
  • Male
  • Inpatients
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Freburger, J. K., Pastva, A. M., Coleman, S. W., Peter, K. M., Kucharska-Newton, A. M., Johnson, A. M., … COMPASS team, . (2022). Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial. Arch Phys Med Rehabil, 103(5), 882-890.e2. https://doi.org/10.1016/j.apmr.2021.10.015
Freburger, Janet K., Amy M. Pastva, Sylvia W. Coleman, Kennedy M. Peter, Anna M. Kucharska-Newton, Anna M. Johnson, Matthew A. Psioda, et al. “Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial.Arch Phys Med Rehabil 103, no. 5 (May 2022): 882-890.e2. https://doi.org/10.1016/j.apmr.2021.10.015.
Freburger JK, Pastva AM, Coleman SW, Peter KM, Kucharska-Newton AM, Johnson AM, et al. Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial. Arch Phys Med Rehabil. 2022 May;103(5):882-890.e2.
Freburger, Janet K., et al. “Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial.Arch Phys Med Rehabil, vol. 103, no. 5, May 2022, pp. 882-890.e2. Pubmed, doi:10.1016/j.apmr.2021.10.015.
Freburger JK, Pastva AM, Coleman SW, Peter KM, Kucharska-Newton AM, Johnson AM, Psioda MA, Duncan PW, Bushnell CD, Rosamond WD, Jones SB, COMPASS team. Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial. Arch Phys Med Rehabil. 2022 May;103(5):882-890.e2.
Journal cover image

Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

May 2022

Volume

103

Issue

5

Start / End Page

882 / 890.e2

Location

United States

Related Subject Headings

  • United States
  • Stroke Rehabilitation
  • Stroke
  • Skilled Nursing Facilities
  • Rehabilitation Centers
  • Rehabilitation
  • Patient Discharge
  • Medicare
  • Male
  • Inpatients