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COMPASS Study Identifies Massive Gaps in Stroke Rehabilitation Care Reasons for these gaps must be identified and addressed.

L ess than half of patients sent home after hos- pitalization for a stroke who are referred for home health and outpatient rehabilitation care receive this service, according to preliminary results of the COMprehensive Post-Acute Stroke Services (COMPASS) Study, presented at ISC 2018. Cheryl Bushnell, MD, of Wake Forest Baptist Health in Winston Salem, North Carolina, and colleagues are currently conducting the COMPASS study, a cluster-randomized pragmatic trial in which 41 North Carolina hospitals are randomized to man- age patients discharged home following a stroke or transient ischemic attack with usual care or the COMPASS care model. The COMPASS care plan involves a 2-day tele- phone 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 care plan integrated with a community-specific resource database; and additional follow-up calls at 30 and 60 days post- stroke discharge. Dr. Bushnell and colleagues analyzed data on 369 patients who were randomized to the COM- PASS care plan and who completed the post-acute clinic visit within 14 days, as well as the 30-day call between July 2016 and May 15, 2017. Patients who were referred to rehabilitation services at hospi- tal discharge or at the clinic visit reported whether they received home health (HH) and outpatient (OP) rehabilitation services during the 30-day call.

" It is sobering that so few patients actually receive services when providers are ordering these services with a genuine clinical indication in mind. "

“It is very important to assess receipt of therapy services using a process that is [close] to real time,” Dr. Bushnell told Elsevier’s PracticeUpdate . “We know which patients were referred for therapy through our data collection, then we assess receipt of services at 30 and 60 days and feed this informa- tion back to participating sites. In most analyses of this type, it is analyzed years later because of the time it takes for administrative data to be compiled.” Overall, receipt of services could be ascertained for 47.7% of the 369 patients. Of the 115 patients referred to HH, 43.5% received it. Of the 85 patients referred to OP therapy, 34.1% received it. There were no differences in sociodemographic charac- teristics among those who did and did not receive HH services, but non-whites were less likely than whites to receive OP services (15% vs 34.9%, respectively). After adjustment for National Insti- tutes of Health Stroke Score, ambulatory status at hospital admission, and age, non-white patients had a 78% decreased odds of receiving OP ther- apy (95% CI 0.05–0.95; P = .04). “It is sobering that so few patients actually receive services when providers are ordering these ser- vices with a genuine clinical indication in mind,” Dr. Bushnell said. “Understanding the circum- stances for why the patients did not receive it is the next step. We assume it is insurance-driven (due to co-pays, etc.), but we also assume there are other barriers, such as transportation. These results will need to be validated with our larger analysis.” She noted that the findings remain preliminary, as the trial is ongoing. Currently, there are issues with missing data, which may introduce bias into the results. Their final analysis is expected to be pub- lished in the late fall of 2018. In addition, the trial only includes patients who are discharged directly home, and their average stroke severity is fairly mild. About 60% of the patients in the COMPASS study were not referred for any rehabilitation ser- vices at discharge. Dr. Bushnell recommended that physicians can help optimize the likelihood that their patients receive the stroke rehabilitation care they need by, “hav- ing clinic or hospital personnel following up with patients. … In the cases of under-insured or self-pay patients, having charity care or financial assistance

Dr. Cheryl Bushnell

programs are also helpful.” www.practiceupdate.com/c/63680

© American Heart Association/ISC 2018

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