Key result
Receiving the COMPASS-TC intervention, including a 14-day clinic visit, significantly improved 90-day physical function compared to not receiving a visit (adjusted mean difference 3.84).
Why the study?
To evaluate the implementation of the COMPASS comprehensive transitional care model across 20 hospitals randomized to the intervention using the RE-AIM framework.
Does comprehensive transitional care improve 90-day physical function in stroke and TIA patients discharged home?
RCT (n=2,751)
Single-blind
Cluster-randomized
Yes
Does comprehensive transitional care improve 90-day physical function in stroke and TIA patients discharged home?
Mean Difference: 3.84 (95% CI 1.42–6.27)
Absolute Event Rate: 83% vs 78.7%
p-value: p=0.002
Implementation of a comprehensive transitional care model for stroke and TIA patients varied widely, but receiving the intervention was associated with better 90-day functional status.
14-day visit attendance was associated with better post-stroke physical function; extends evidence for transitional care components despite variable uptake.
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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Gesell et al. (2019) conducted an RCT in Stroke or transient ischemic attack (TIA) (n=2,751). COMPASS-TC (comprehensive transitional care) vs. No COMPASS-TC visit was evaluated on 90-day physical function (Stroke Impact Scale-16) (MD 3.84, 95% CI 1.42-6.27, p=0.002). Receiving the COMPASS-TC intervention, including a 14-day clinic visit, significantly improved 90-day physical function compared to not receiving a visit (adjusted mean difference 3.84).
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