Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Duncan, Pamela W.; Bushnell, Cheryl D.; Jones, Sara B.; Psioda, Matthew A.; Gesell, Sabina B.; D'Agostino, Ralph B.; Sissine, Mysha E.; Coleman, Sylvia W.; Johnson, Anna M.; Barton-Percival, Blair F.; Prvu-Bettger, Janet; Calhoun, Adrienne G.; Cummings, Doyle M.; Freburger, Janet K.; Halladay, Jacqueline R.; Kucharska-Newton, Anna M.; Lundy-Lamm, Gladys; Lutz, Barbara J.; Mettam, Laurie H.; Pastva, Amy M.; Xenakis, James G.; Ambrosius, Walter T.; Radman, Meghan D.; Vetter, Betsy; Rosamond, Wayne D.
• Is Part Of: Circulation. Volume 13:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: blood pressure monitoring, ambulatory -- clinical trial -- patient-centered care -- patient-reported outcome measures -- stroke -- transitional care; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Research -- Periodicals; Outcome assessment (Medical care) -- Periodicals; Evidence-based medicine -- Periodicals; 616.1007
• DOI: 10.1161/CIRCOUTCOMES.119.006285
• Languages: English
• ISSNs: 1941-7713

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text.