The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial

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  • Duncan, Pamela W
    • Other Affiliation: Wake Forest School of Medicine
  • Bushnell, Cheryl D
    • Other Affiliation: Wake Forest School of Medicine
  • Rosamond, Wayne D.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Jones Berkeley, Sara B
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Gesell, Sabina B
    • Other Affiliation: Wake Forest School of Medicine
  • D’Agostino, Ralph B
    • Other Affiliation: Wake Forest School of Medicine
  • Ambrosius, Walter T
    • Other Affiliation: Wake Forest School of Medicine
  • Barton-Percival, Blair
    • Other Affiliation: Piedmont Triad Regional Council Area Agency on Aging
  • Bettger, Janet P
    • Other Affiliation: Duke University School of Medicine
  • Coleman, Sylvia W
    • Other Affiliation: Wake Forest School of Medicine
  • Cummings, Doyle M
    • Other Affiliation: East Carolina University
  • Freburger, Janet K
    • Other Affiliation: University of Pittsburgh
  • Halladay, Jacqueline R.
    • Affiliation: School of Medicine, Department of Family Medicine
  • Johnson, Anna M
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Kucharska-Newton, Anna
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Lundy-Lamm, Gladys
    • Other Affiliation: Minority Women Health Alliance (TriStroke)
  • Lutz, Barbara J
    • Other Affiliation: University of North Carolina Wilmington School of Nursing
  • Mettam, Laurie H
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Pastva, Amy M
    • Other Affiliation: Duke University
  • Sissine, Mysha E
    • Other Affiliation: Wake Forest School of Medicine
  • Vetter, Betsy
    • Other Affiliation: American Heart Association
Abstract
  • Background Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes. Methods Forty-one hospitals in North Carolina were randomized (as 40 units) to either implement the COMPASS care model or continue their usual care. The recruitment goal is 6000 patients (3000 per arm). Hospital staff ascertain and enroll patients discharged home with a clinical diagnosis of stroke or transient ischemic attack. Patients discharged from intervention hospitals receive 2-day telephone follow-up; a comprehensive clinic visit within 2 weeks that includes a neurological evaluation, assessments of social and functional determinants of health, and an individualized COMPASS Care Plan™ integrated with a community-specific resource database; and additional follow-up calls at 30 and 60 days post-stroke discharge. This model is consistent with the Centers for Medicare and Medicaid Services transitional care management services provided by physicians or advanced practice providers with support from a nurse to conduct patient assessments and coordinate follow-up services. Patients discharged from usual care hospitals represent the control group and receive the standard of care in place at that hospital. Patient-centered outcomes are collected from telephone surveys administered at 90 days. The primary endpoint is patient-reported functional status as measured by the Stroke Impact Scale 16. Secondary outcomes are: caregiver strain, all-cause readmissions, mortality, healthcare utilization, and medication adherence. The study engages patients, caregivers, and other stakeholders (including policymakers, advocacy groups, payers, and local community coalitions) to advise and support the design, implementation, and sustainability of the COMPASS care model. Discussion Given the high societal and economic burden of stroke, identifying a care model to improve recovery, independence, and quality of life is critical for stroke survivors and their caregivers. The pragmatic trial design provides a real-world assessment of the COMPASS care model effectiveness and will facilitate rapid implementation into clinical practice if successful. Trial registration Clinicaltrials.gov: NCT02588664 ; October 23, 2015.
Date of publication
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  • Article
Rights statement
  • In Copyright
Rights holder
  • The Author(s).
Journal title
  • BMC Neurology
Journal volume
  • 17
Journal issue
  • 1
Language
  • English
Bibliographic citation
  • BMC Neurology. 2017 Jul 17;17(1):133
Publisher
  • BioMed Central

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