Access to and effectiveness of community-based rehabilitation after stroke

项目摘要/摘要 全面的急性卒中后服务(COMPASS)研究，在卒中带实施 北卡罗来纳州(北卡罗来纳州)的这项研究是中风综合过渡期护理的务实试验。40家医院被 随机提供过渡期护理模式(COMPASS-TC)或普通护理。Compass-TC支持 中风后的教育、二级预防、康复和康复。该模型的一个关键组件是 运动要务活动计划。这是一个以证据为基础的康复计划，以最大限度地提高幸存者 家庭和社区的健康、康复和功能。 COMPASS研究及其先锋网站收集了11,000多名住院的NC患者的数据 中风或短暂性脑缺血发作(TIA)出院。基线数据提供了丰富的信息 控制可能影响康复使用(即PT/OT就诊)和患者的患者和临床特征 结果。两天通话和门诊访问数据包括有关社交、行为和功能方面的信息 除了临床信息之外，还有健康的决定因素。90天的结果包括几个重要的 患者报告的测量包括中风影响量表-16。将指南针数据链接到NC 行政索赔数据在指南针样本中提供了有关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可靠的数据集 一个大而多样的样本。对这些数据的分析为解决以下方面的差距提供了巨大机会 了解康复护理(即物理和职业治疗)的使用情况和效果 卒中。利用这些数据，我们提出了以下三个目标：目标1-确定个人、医院和 社区层面与康复使用相关的因素以及COMPASS-TC控制的程度 社会人口学和地理关系；目标2-检查COMPASS-TC对康复的影响 使用；目标3--评估康复使用与患者报告和医疗保健之间的关系 利用结果以及收到COMPASS-TC是否缓和了这些关系；以及以下2 探索性目标：探索性目标1--考察社会、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获得)和康复使用； 探索性目标2--评估临床数据在控制方面的附加效益 因为有征兆而造成混乱。 这项研究的结果将填补我们对社区基础设施的使用和有效性的理解方面的空白 康复背景下的“现实世界”护理，将决定全面康复的有效性 过渡性护理模式在改善中风幸存者获得/使用康复和预后方面的作用。是这样的 随着越来越多的人在中风中幸存下来，随着美国医疗体系的发展，信息至关重要 向基于价值的护理提供转变(例如，捆绑支付、负责任的护理组织、过渡期护理)。

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).