Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA

The Cluster-randomized Compass Study

Datos Bibliográficos

ID9101965
AutoresAnna M Kucharska-Newton (0000-0001-9864-467X, University of North Carolina at Chapel Hill, autor de correspondencia), Jacquie R Halladay (University of North Carolina at Chapel Hill), Jacquie Halladay (University of North Carolina at Chapel Hill), Matthew A Psioda (0000-0002-4450-6981, University of North Carolina at Chapel Hill), Sara B Jones (University of Kentucky, autor de correspondencia), Anna Johnson (0000-0001-5120-4837, University of North Carolina at Chapel Hill, autor de correspondencia), Anna M Johnson (University of Kentucky), Sylvia W Coleman (0000-0003-4916-2839, Department of Neurology, Wake Forest School of Medicine, Winston-Salem), Doyle M Cummings (0000-0002-8237-7885, East Carolina University), Janet K Freburger (0000-0001-8467-9468, University of Pittsburgh), Laurie C Daras (Insight Policy Research Arlington, VA, autor de correspondencia), Wayne D Rosamond (0000-0001-5271-074X, University of Kentucky, autor de correspondencia), Pamela W Duncan (0000-0002-4838-3253, Department of Neurology, Wake Forest School of Medicine, Winston-Salem), Cheryl D Bushnell (Department of Neurology, Wake Forest School of Medicine, Winston-Salem), Cheryl Bushnell (0000-0002-3162-7610, Wake Forest University)
Año2023
Volumen61
Número3
Páginas137-144
Fecha de publicación2023-03-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001798
PMID36729552
OpenAlexW4318933535
IdiomaEN
Referencias citadas28

BACKGROUND AND OBJECTIVES: We examined transitional care management within 90 days and 1 year following discharge home among acute stroke and transient ischemic attack patients from the Comprehensive Post-Acute Stroke Services (COMPASS) Study, a cluster-randomized pragmatic trial of early supported discharge conducted in 41 hospitals (40 hospital units) in North Carolina, United States. METHODS: Data for 2262 of the total 6024 (37.6%; 1069 intervention and 1193 usual care) COMPASS patients were linked with the Centers for Medicare and Medicaid Services fee-for-service Medicare claims. Time to the first ambulatory care visit was examined using Cox proportional hazard models adjusted for patient characteristics not included in the randomization protocol. RESULTS: Only 6% of the patients [mean (SD) age 74.9 (10.2) years, 52.1% women, 80.3% White)] did not have an ambulatory care visit within 90 days postdischarge. Mean time (SD) to first ambulatory care visit was 12.0 (26.0) and 16.3 (35.1) days in intervention and usual care arms, respectively, with the majority of visits in both study arms to primary care providers. The COMPASS intervention resulted in a 27% greater use of ambulatory care services within 1 year postdischarge, relative to usual care [HR=1.27 (95% CI: 1.14-1.41)]. The use of transitional care billing codes was significantly greater in the intervention arm as compared with usual care [OR=1.87 (95% CI: 1.54-2.27)]. DISCUSSION: The COMPASS intervention, which was aimed at improving stroke post-acute care, was associated with an increase in the use of ambulatory care services by stroke and transient ischemic attack patients discharged home and an increased use of transitional care billing codes by ambulatory providers

Acute care · Ambulatory · Ambulatory care · Confidence interval · Hazard ratio · Health care · Intervention (counseling) · Medicaid · Physical therapy · Randomization · Randomized controlled trial · Stroke (engine) · Transitional care · Acute Ischemic Stroke Management · Emergency Medicine · Internal Medicine · Medicine · Nursing · Palliative Care and End-of-Life Issues · Stroke Rehabilitation and Recovery