Access to and effectiveness of community-based rehabilitation after stroke

项目总结/摘要 急性卒中后综合服务（COMPASS）研究，在整个卒中带实施 是一个务实的试验全面过渡照顾中风。40家医院 随机分配至过渡护理模式（COMPASS-TC）或常规护理。COMPASS-TC支持 中风后的教育、二级预防、康复和恢复。该模型的一个关键组成部分是 运动事项活动计划。这是一个循证康复计划，以最大限度地提高幸存者 健康，恢复，以及在家庭和社区的功能。 COMPASS研究及其Vanguard网站收集了超过11，000名住院NC患者的数据 中风或短暂性脑缺血发作（TIA），出院回家。基线数据提供了丰富的信息， 控制可能影响康复使用的患者和临床特征（即，PT/OT访视）和患者 结果。两天的电话和诊所访问数据包括社会，行为和功能信息 健康的决定因素，除了临床信息。90天的成果包括几个重要的 患者报告的指标，包括卒中影响量表-16。COMPASS数据与NC的连接 行政索赔数据提供了COMPASS样本中康复使用的有效信息。 COMPASS研究和行政索赔数据一起构成了一个独特而强大的数据集， 一个庞大而多样的样本。对这些数据的分析提供了一个巨大的机会， 了解康复护理的使用和有效性（即，物理和职业治疗） 中风利用这些数据，我们提出了以下3个目标：目标1 -确定个人，医院， 与康复使用相关的社区因素以及COMPASS-TC调节的程度 社会人口和地理关系;目标2 -检查COMPASS-TC对康复的影响 使用;目的3 -评价康复使用与患者报告和医疗保健之间的关系 使用结果以及COMPASS-TC的接收是否调节这些关系;以及以下2 探索性目标：探索性目标1-检查社会，行为和功能之间的关系 健康决定因素（作为COMPASS-TC电子护理计划的一部分）和康复使用; 探索性目标2-评价临床数据在控制 因适应症而混淆。 这项研究的结果将填补我们对社区为基础的 在“真实的世界”的背景下进行康复护理，并将决定一个全面的 过渡性护理模式在改善中风幸存者获得/使用康复和结局方面的作用。等 随着越来越多的人在中风中幸存下来，随着美国医疗保健系统的发展， 转向基于价值的护理提供（例如，捆绑支付、负责任的护理组织、过渡性护理）。

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).