Access to and effectiveness of community-based rehabilitation after stroke

中风后社区康复的可及性和有效性

• 批准号: 10654785
• 负责人: JANET Kues FREBURGER
• 金额: $ 65.37万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-08 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654785
• 关键词: Address; Adverse event; American; Behavioral; Caring; Characteristics; Clinic; Clinic Visits; Clinical; Clinical Data; Communities; Data; Data Analyses; Data Set; Development; Disparity; Education; Effectiveness; Electronics; Geography; Health; Health system; Healthcare Systems; Home; Hospitalization; Hospitals; Impaired cognition; Improve Access; Individual; Intervention; Measures; Modeling; Movement; North Carolina; Occupational Therapist; Occupational Therapy; Outcome; Patient Discharge; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Physical Function; Physical therapy; Play; Policies; Population Study; Provider; Race; Randomized; Recovery; Recurrence; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Risk; Sampling; Secondary Prevention; Services; Site; Stroke; Stroke Belt; Survivors; Telephone; Transient Ischemic Attack; Visit; accountable care organization; acute care; acute stroke; bundled payment; care delivery; care episode; community-level factor; differences in access; effectiveness evaluation; efficacy study; evidence base; experience; falls; geographic disparity; health care service utilization; health determinants; hospital readmission; motor impairment; personalized care; physical therapist; post stroke; pragmatic trial; primary endpoint; programs; rehabilitative care; secondary endpoint; social; sociodemographic disparity; sociodemographics; socioeconomics; stroke outcome; stroke recovery; stroke rehabilitation; stroke survivor; systematic review; treatment as usual

PROJECT SUMMARY/ABSTRACT The Comprehensive Post-Acute Stroke Services (COMPASS) Study, implemented across the stroke belt of North Carolina (NC), is a pragmatic trial of comprehensive transitional care for stroke. Forty hospitals were randomized to deliver the transitional care model (COMPASS-TC) or usual care. COMPASS-TC supports education, secondary prevention, rehabilitation and recovery following stroke. A key component of the model is the Movement Matters Activity Program. It is an evidence-based rehabilitation program to maximize survivor health, recovery, and function in the home and community. The COMPASS Study and its Vanguard site have collected data on over 11,000 NC patients hospitalized for stroke or transient ischemic attack (TIA) and discharged home. Baseline data provide rich information to control patient and clinical characteristics that may influence rehabilitation use (i.e., PT/OT visits) and patient outcomes. Two-day call and clinic visit data include information on social, behavioral, and functional determinants of health, in addition to clinical information. Ninety-day outcomes include several important patient-reported measures including the Stroke Impact Scale-16. Linkage of COMPASS data to NC administrative claims data provide valid information on rehabilitation use in the COMPASS sample. Together, the COMPASS Study and administrative claims data constitute a unique and robust data set on a large and diverse sample. Analyses of these data provide a tremendous opportunity to address gaps in understanding the use and effectiveness of rehabilitation care (i.e., physical and occupational therapy) after stroke. Using these data, we propose the following 3 aims: Aim 1 - Identify individual, hospital, and community-level factors associated with rehabilitation use and the extent to which COMPASS-TC moderates sociodemographic and geographic relationships; Aim 2 - Examine the effect of COMPASS-TC on rehabilitation use; Aim 3 - Evaluate the relationship between rehabilitation use and patient-reported and healthcare utilization outcomes and whether receipt of COMPASS-TC moderates these relationships; and the following 2 exploratory aims: Exploratory Aim 1- Examine the relationship between social, behavioral, and functional determinants of health (captured as part of the COMPASS-TC electronic care plan) and rehabilitation use; Exploratory Aim 2- Evaluate the added benefit of clinical data over and above claims-based data in controlling for confounding by indication. Results of this study will fill gaps in our understanding of the use and effectiveness of community-based rehabilitation in the context of “real world” care and will determine the effectiveness of a comprehensive transitional care model in improving access to/use of rehabilitation and outcomes for stroke survivors. Such information is critical as more individuals are surviving stroke and as the U.S. healthcare system moves towards value-based care delivery (e.g., bundled payments, accountable care organizations, transitional care).

项目总结/文摘

项目成果

Stroke in Women and Unique Risk Factors.

女性中风和独特的危险因素。

• DOI: 10.1161/strokeaha.122.041734
• 发表时间: 2023
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Bushnell,CherylD;Kapral,MoiraK
• 通讯作者: Kapral,MoiraK

Referral to Community-Based Rehabilitation Following Acute Stroke: Findings From the COMPASS Pragmatic Trial.

急性中风后转介至社区康复：COMPASS 实用试验的结果。

• DOI: 10.1161/circoutcomes.123.010026
• 发表时间: 2024
• 期刊: Circulation. Cardiovascular quality and outcomes
• 作者: JonesBerkeley,SaraB;Johnson,AnnaM;Mormer,ElizabethR;Ressel,Kristin;Pastva,AmyM;Wen,Fang;Patterson,CharityG;Duncan,PamelaW;Bushnell,CherylD;Zhang,Shuqi;Freburger,JanetK
• 通讯作者: Freburger,JanetK