1. Identifying Actionable Post-Acute Stroke Concerns:
The COMprehensive Post-Acute Stroke Services eCOMPASS© Care Plan
Cheryl Bushnell, MD, MHS; Pamela Duncan, PhD; Rica Abbott, MPH; Scott Rushing; Jeanette Stafford, MS; Barbara Lutz, PhD; Sara Jones, PhD; Janet Prvu-Bettger, ScD; Ralph D’Agostino, Jr., PhD
Background
After discharge, stroke patients are at increased risk for rehospitalization, long-term disability, and death.1
However, 45% of all stroke patients receive no post-acute services.2
Comprehensive, individualized referrals are needed to provide the right care, at the right time, at the point of care for stroke patients/caregivers post-discharge.
Methods
COMPASS Study
A cluster-randomized pragmatic trial of a comprehensive post-acute stroke care model in 41 NC hospitals 3
Figure 1. COMPASS Hospitals
Methods continued
eCOMPASS© Care Plan
Captures goals for care, physical, social and medical function, health literacy, and medication management
Utilizes standardized assessments from 2-day call and clinic visit within 14 days
Proprietary algorithms generate provider reports and care plans at the point of care, with recommendations based on specific concerns
Definition of the domains identified as a concern in eCOMPASS© Care Plan:
Numbers: BP > 140 mm Hg at clinic visit
Engage: Physical mobility /safety or referral for HH or outpatient PT/OT/ST
Support: Patient or family stress, lack of social support
Willingness Low medication adherence or polypharmacy
Results
Table 1 shows results from the first 342 patients with complete eCOMPASS© care plans who had identified concerns for each domain, enrolled July 2016 to April 1, 2017.
Compared to patients without concerns, there were significant differences in patients identified as needing services by age, gender, insurance type, NIHSS, and metro/micro/rural status, but not race or ethnicity.
Table 1. Selected Patient and Hospital Characteristics of patients with eCOMPASS© Care Plan Domains Identified As Concerns, N=342
*p<0.05; †p<0.01; ‡p<0.001 for association between domain flagged vs. not flagged and characteristic; § Insurance types are not mutually exclusive and may sum to >100%; **Missing values excluded, Denominator <342.
Associations were evaluated using Chi-square or Fisher’s exact test and t-test or Wilcoxon rank-sum test.
BP = Blood Pressure; HH = home health; ICH= Intracerebral Hemorrhage; NIHSS = NIH Stroke Scale; OT = Occupational Therapy; PT = Physical Therapy; Q = Quartile; ST = Speech Therapy; TIA = Transient Ischemic Attack; VA = Veteran’s Administration.
Conclusions
Comprehensive assessments at the point of care identified a substantial number of patient / caregiver needs within each COMPASS© domain.
The full COMPASS trial will determine whether this model improves outcome after stroke.
References
1 Cutler & Ghosh, NEJM, 2012;366:1075.
2 Bettger, et al., JAHA, 2015;4:e
3 Duncan, et al., 2017, Submitted
FUNDING ACKNOWLEDGEMENT: This work was partially supported through a Patient-Centered Outcomes Research Institute PCORI Award PCS
REDCAP: We would like to acknowledge the REDCap support of the Wake Forest Clinical and Translational Science Institute WF CTSI, which is supported by the National Center for Advancing Translational Sciences NCATS, National Institutes of Health, through Grant Award Number UL1TR
DISCLAIMER: All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute PCORI, its Board of Governors or Methodology Committee.
NCT Number for ClinicalTrials.gov: NCT
Study Website: nccompass-study.org