A Person‐Centered Approach to Poststroke Care: The COMprehensive Post‐Acute Stroke Services Model

Bushnell, Cheryl; Duncan, Pamela W.; Lycan, Sarah; Condon, Christina; Pastva, Amy M.; Lutz, Barbara; Halladay, Jacqueline R.; Cummings, Doyle M.; Arnan, Martinson; Jones, Steve; Sissine, Mysha; Coleman, Sylvia; Johnson, Anna; Gesell, Sabina B.; Mettam, Laurie H.; Freburger, Janet K.; Barton-Percival, Blair; Taylor, Karen; Prvu‐Bettger, Janet; Lundy-Lamm, Gladys; Rosamond, Wayne D.

doi:10.1111/jgs.15322

Cited by 34 publications

(26 citation statements)

References 37 publications

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“…Hospitals had flexibility in their COMPASS clinic setting (neurology clinic, hospital-based non-specialty clinic, primary care provider (PCP) clinic). During the clinic visit, the PAC/APP performed a standardized assessment of the patient’s functional status, medical and neurological care needs, social determinants of health, and caregiver’s capacity for assisting the patient during recovery [15, 16]. The results of the comprehensive assessment were captured electronically and generated an individualized electronic care plan (eCare Plan) that was shared with the patient, caregiver, PCP, and home health and outpatient therapy where applicable.…”

Section: Methodsmentioning

confidence: 99%

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

Gesell

Bushnell

Jones

et al. 2019

BMC Health Serv Res

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BackgroundThe 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.MethodsWe 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.ResultsAdoption: 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.ConclusionsCOMPASS-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 registrationClinicalTrials.gov number: NCT02588664. Registered 28 October 2015.

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Section: Methodsmentioning

confidence: 99%

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

Gesell

Bushnell

Jones

et al. 2019

BMC Health Serv Res

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“…The COMprehensive Post-Acute Stroke Services transitional care (COMPASS-TC) intervention was designed for scalability and sustainability and was aligned with the Centers for Medicare and Medicaid Services transitional care management reimbursement models. 17 Core elements included a telephone call at 2 days and a face-to-face clinic visit within 7−14 days post-discharge. Standardized clinical assessments were used to generate individualized electronic care (eCare) plans delivered at the clinic visit.…”

Section: The Comprehensive Post-acute Stroke Services Study Designmentioning

confidence: 99%

Methodological Challenges and Statistical Approaches in the COMprehensive Post-Acute Stroke Services Study

Psioda

Jones²,

Xenakis

et al. 2021

Medical Care

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Background: The COMprehensive Post-Acute Stroke Services study was a cluster-randomized pragmatic trial designed to evaluate a comprehensive care transitions model versus usual care. The data collected during this trial were complex and analysis methodology was required that could simultaneously account for the cluster-randomized design, missing patient-level covariates, outcome nonresponse, and substantial nonadherence to the intervention. Objective: The objective of this study was to discuss an array of complementary statistical methods to evaluate treatment effectiveness that appropriately addressed the challenges presented by the complex data arising from this pragmatic trial. Methods: We utilized multiple imputation combined with inverse probability weighting to account for missing covariate and outcome data in the estimation of intention-to-treat effects (ITT). The ITT estimand reflects the effectiveness of assignment to the COMprehensive Post-Acute Stroke Services intervention compared with usual care (ie, it does not take into account intervention adherence). Per-protocol analyses provide complementary information about the effect of treatment, and therefore are relevant for patients to inform their decision-making. We describe estimation of the complier average causal effect using an instrumental variables approach through 2-stage least squares estimation. For all preplanned analyses, we also discuss additional sensitivity analyses. Discussion: Pragmatic trials are well suited to inform clinical practice. Care should be taken to proactively identify the appropriate balance between control and pragmatism in trial design. Valid estimation of ITT and per-protocol effects in the presence of complex data requires application of appropriate statistical methods and concerted efforts to ensure high-quality data are collected.

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“…Early supported discharge (ESD) encompasses a form of rehabilitation for people with mild to moderate stroke that accelerates their discharge from the acute setting to the home environment in order to continue their rehabilitation as an alternative to conventional care ( Langhorne, 1995 ; Mas & Inzitari, 2015 ; Rodgers et al , 1997 ; Teasell et al , 2009 ). As ESD rehabilitation largely takes place within the person’s home, goals set are more realistic and more relevant to the person with stroke as well as being person-centred ( Bushnell et al , 2018 ; Cowles et al , 2017 ; Langhorne & Widen-Holmqvist, 2007 ; Sunnerhagen et al , 2013 ). The recent National Institute for Health and Care Excellence (NICE) guidelines recommend that the ESD team should be multi-disciplinary with the rehabilitation at home consisting of an intensity equivalent to the rehabilitation received within an acute stroke unit ( NICE, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke

et al. 2020

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Early supported discharge (ESD) facilitates a person with a stroke to be discharged from the acute hospital environment earlier than conventional care to continue their rehabilitation within the home with members of the multi-disciplinary team. A number of quantitative studies have highlighted benefits of ESD including a reduction in the length of inpatient stay, cost savings, as well as reducing long term dependency. This systematic review and qualitative synthesis explores the perspectives and experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals involved in the delivery of the service. A comprehensive literature search will be completed in the following databases CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service will be included. Methodological quality will be appraised using the ten-item Critical Appraisal Skills Programme checklist for qualitative research by two independent reviewers with a third reviewer involved should differences of opinion arise. Findings will be synthesised using thematic synthesis. It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services. PROSPERO registration: CRD42020135197 – 28/04/2020

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A Person‐Centered Approach to Poststroke Care: The COMprehensive Post‐Acute Stroke Services Model

Cited by 34 publications

References 37 publications

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

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

Methodological Challenges and Statistical Approaches in the COMprehensive Post-Acute Stroke Services Study

A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke

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