| Titre : | Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial (2022) |
| Auteurs : | Janet K. Freburger ; Amy M. Pastva ; Sylvia W. Coleman ; Kennedy M. Peter ; Anna M. Kucharska-Newton ; Anna M. Johnson ; Matthew A. Psioda ; Pamela W. Duncan ; Cheryl D. Bushnell ; Wayne D. Rosamond ; Sara B. Jones |
| Type de document : | Article |
| Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 103, n° 5, 2022) |
| Article en page(s) : | p. 882-890.e2 |
| Note générale : | https://doi.org/10.1016/j.apmr.2021.10.015 |
| Langues: | Anglais |
| Descripteurs : |
HE Vinci Accident vasculaire cérébral (AVC) ; Centres de rééducation et de réadaptation ; Établissements de soins qualifiés ; Réadaptation |
| Résumé : |
Objectives
To examine the effect of a comprehensive transitional care model on the use of skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care in the 12 months after acute care discharge home following stroke; and to identify predictors of experiencing a SNF or IRF admission following discharge home after stroke. Design Cluster randomized pragmatic trial Setting Forty-one acute care hospitals in North Carolina. Participants 2262 Medicare fee-for-service beneficiaries with transient ischemic attack or stroke discharged home. The sample was 80.3% White and 52.1% female, with a mean (SD) age of 74.9 (10.2) years and a mean ± SD National Institutes of Health stroke scale score of 2.3 (3.7). Intervention Comprehensive transitional care model (COMPASS-TC), which consisted of a 2-day follow-up phone call from the postacute care coordinator and 14-day in-person visit with the postacute care coordinator and advanced practice provider. Main Outcome Measures Time to first SNF or IRF and SNF or IRF admission (yes/no) in the 12 months following discharge home. All analyses utilized multivariable mixed models including a hospital-specific random effect to account for the non-independence of measures within hospital. Intent to treat analyses using Cox proportional hazards regression assessed the effect of COMPASS-TC on time to SNF/IRF admission. Logistic regression was used to identify clinical and non-clinical predictors of SNF/IRF admission. Results Only 34% of patients in the intervention arm received COMPASS-TC per protocol. COMPASS-TC was not associated with a reduced hazard of a SNF/ IRF admission in the 12 months post-discharge (hazard ratio, 1.20, with a range of 0.95-1.52) compared to usual care. This estimate was robust to additional covariate adjustment (hazard ratio, 1.23) (0.93-1.64). Both clinical and non-clinical factors (ie, insurance, geography) were predictors of SNF/IRF use. Conclusions COMPASS-TC was not consistently incorporated into real-world clinical practice. The use of a comprehensive transitional care model for patients discharged home after stroke was not associated with SNF or IRF admissions in a 12-month follow-up period. Non-clinical factors predictive of SNF/IRF use suggest potential issues with access to this type of care. |
| Disponible en ligne : | Oui |
| En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999321015252#! |
Bibliothèques HE Vinci
