Background
The
objectives of this study were to develop and test in real-world
clinical practice the effectiveness of a comprehensive postacute stroke
transitional
care (TC) management program.
Methods and Results
The
COMPASS study (Comprehensive Post-Acute Stroke Services) was a
pragmatic cluster-randomized trial where the hospital was the unit of
randomization. The intervention (COMPASS-TC) was initiated at 20
hospitals, and 20 hospitals provided their usual care. Hospital staff
enrolled 6024 adult stroke and transient ischemic attack patients
discharged home between 2016 and 2018. COMPASS-TC was patient-centered
and assessed social and functional determinates of health to inform
individualized care plans. Ninety-day outcomes were evaluated by blinded
telephone interviewers. The primary outcome was functional status
(Stroke Impact Scale-16); secondary outcomes were mortality, disability,
medication adherence, depression, cognition, self-rated health,
fatigue, care satisfaction, home blood pressure monitoring, and falls.
The primary analysis was intention to treat. Of intervention hospitals,
58% had uninterrupted intervention delivery. Thirty-five percent of
patients at intervention hospitals attended a COMPASS clinic visit. The
primary outcome was measured for 59% of patients and was not
significantly influenced by the intervention. Mean Stroke Impact
Scale-16 (±SD) was 80.6±21.1 in TC versus 79.9±21.4 in usual care. Home
blood pressure monitoring was self-reported by 72% of intervention
patients versus 64% of usual care patients (adjusted odds ratio, 1.43
[95% CI, 1.21–1.70]). No other secondary outcomes differed.
Conclusions
Although
designed according to the best available evidence with input from
various stakeholders and consistent with Centers for Medicare and
Medicaid Services TC policies, the COMPASS model of TC was not
consistently incorporated into real-world health care. We found no
significant effect of the intervention on functional status at 90 days
post-discharge.
Registration
URL:
https://www.clinicaltrials.gov; Unique identifier: NCT02588664.
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