Impact of a comprehensive transitional care management model on use of community‐based rehabilitation after stroke

Background Community‐based physical and occupational therapy (PT/OT) are critical for stroke recovery but are underutilized. We conducted a secondary analysis of the COMPASS Study, a pragmatic trial of comprehensive post‐acute transitional care (TC) to investigate whether TC programs increase PT/OT use. Methods Forty hospitals were randomized to implement COMPASS‐TC or maintain usual care (UC) for patients with stroke/TIA. In a crossover phase, UC hospitals implemented COMPASS‐TC. We linked participants to administrative claims to assess PT/OT use after stroke. Adjusted GEE compared COMPASS‐TC to UC within the trial and crossover cohorts on 30/90‐day PT/OT use, time to first visit, number of visits, and receipt of PT and OT versus single therapy. Per protocol analysis estimated complier average causal effects. Results COMPASS enrolled 8,377 patients from 7/2016‐3/2019; 5,261 were linked to administrative claims. Thirty‐day PT/OT ranged from 22.6% in UC to 37.5% in COMPASS‐TC. Therapy use was similar between groups in the trial cohort, while COMPASS‐TC was associated with increased use in crossover analysis (9.4%, 95% CI 5.6%‐13.3% at 30 days). COMPASS‐TC was consistently associated with a shorter time to therapy (mean difference ‐0.16, ‐0.03 to ‐0.29). Per protocol results were larger for most outcomes. Conclusions COMPASS‐TC was associated with shorter time to PT/OT and with greater therapy receipt in the crossover, but not the trial, analysis. Inconsistencies may reflect confounding or differences in hospitals that chose to adopt the intervention in Phase 2. Implementation studies to improve care transitions after stroke are needed to enhance use of post‐acute rehabilitation.