为中风患者实施可计费的过渡护理模式：COMPASS 研究。
Implementation of a billable transitional care model for stroke patients: the COMPASS study.
机构信息
Department of Social Sciences and Health Policy, Department of Implementation Science, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
出版信息
BMC Health Serv Res. 2019 Dec 19;19(1):978. doi: 10.1186/s12913-019-4771-0.
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.
背景
COMprehensive Post-Acute Stroke Services（COMPASS）实用临床试验比较了全面过渡性护理（COMPASS-TC）与北卡罗来纳州出院回家的中风和短暂性脑缺血发作（TIA）患者的常规护理之间的效果。我们使用 RE-AIM 框架评估了随机分配到干预组的 20 家医院对 COMPASS-TC 的实施情况。
方法
我们评估了医院层面的 COMPASS-TC 采用情况；患者的可及性（符合及时电话和面对面随访的过渡性护理管理要求）；使用医院质量指标进行实施（同期入组、两天电话随访、14 天预约诊所就诊）；以及医院层面的可持续性（维持）。有效性比较了接受 COMPASS-TC 与未接受 COMPASS-TC 的患者 90 天的身体功能（中风影响量表-16）。使用混合逻辑回归模型估计了医院和患者特征与实施和可达性措施之间的关联。
结果
采用：在 95 家符合条件的医院中，有 41 家（43%）参与了试验。在随机分配到干预组的 20 家医院中，有 19 家（95%）开始采用 COMPASS-TC。可达性：共 24%（656/2751）的入组患者接受了计费的 TC 干预，各医院的比例为 6-66%。
实施
在符合条件的入组患者中，75.9%接受了两天的电话随访（或两次尝试），77.5%安排/提供了诊所就诊。大多数完成了就诊（975 例中有 78%）发生在 14 天内。有效性：与未就诊的患者相比，接受 14 天就诊的患者的身体功能更好（调整后的平均差异：3.84，95%置信区间 1.42-6.27，p=0.002）。维持：在采用的 19 家医院中，有 14 家（74%）维持了 COMPASS-TC。
结论
COMPASS-TC 的实施情况差异很大。最大的挑战是接触到患者，因为系统难以保持后续就诊的一致提供，以及患者对接受其他急性后护理的偏好。接受 COMPASS-TC 与更好的功能状态相关。
试验注册
ClinicalTrials.gov 编号：NCT02588664。注册日期：2015 年 10 月 28 日。
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