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: 10116833
• 负责人: JANET Kues FREBURGER
• 金额: $ 70.97万
• 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/10116833
• 关键词: Address; Adverse event; American; Behavioral; Caring; Characteristics; Clinic; Clinic Visits; Clinical; Clinical Data; Communities; Data; Data Analyses; Data Set; Development; Education; Effectiveness; 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 Care; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Physical Function; Physical therapy; Play; Policies; Population Study; Provider; Randomized; Recovery; Recovery of Function; Recurrence; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Risk; Sampling; Secondary Prevention; Services; Site; Stroke; Stroke Belt; Survivors; Telephone; Transient Ischemic Attack; Use Effectiveness; Visit; acute care; acute stroke; base; bundled payment; care delivery; care episode; care outcomes; differences in access; effectiveness evaluation; efficacy study; evidence base; experience; falls; health care service utilization; hospital readmission; motor impairment; personalized care; physical therapist; post stroke; pragmatic trial; primary endpoint; programs; rehabilitative care; secondary endpoint; social; sociodemographics; socioeconomics; 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).

项目摘要/摘要 全面的急性中风服务（Compass）研究，在中风腰带实施 北卡罗来纳州（NC）是对中风的全面过渡护理的务实试验。四十家医院是 随机提供过渡护理模型（Cossaus-TC）或通常的护理。 Cossips-TC支持 中风后教育，二级预防，康复和恢复。模型的关键组成部分是 运动事项活动计划。这是一个基于证据的康复计划，可最大化生存 在家庭和社区中的健康，恢复和功能。 Compass研究及其先锋站点已收集了超过11,000名NC患者住院的数据 用于中风或短暂性缺血发作（TIA）并释放回家。基线数据提供了丰富的信息 控制患者和临床特征可能影响康复使用（即PT/OT访问）和患者 结果。为期两天的电话和诊所访问数据包括有关社交，行为和功能的信息 除临床信息外，健康的决定因素。九十天的结果包括几个重要的 患者报告的措施包括中风影响量表16。指南针数据与NC的联系 行政索赔数据提供了有关指南针样本中有关康复使用的有效信息。 指南针的研究和行政主张数据共同构成了一个独特而强大的数据。 一个大而多样的样本。这些数据的分析为解决差距提供了巨大的机会 了解康复护理的使用和有效性（即物理和占用治疗）之后 中风。使用这些数据，我们提出以下3个目标：目标1-确定个人，医院和 与康复使用相关的社区级因素以及Compass-TC中等程度的程度 社会人口统计学和地理关系； AIM 2-检查Copss -TC对康复的影响 使用;目标3-评估康复使用与患者报告与医疗保健之间的关系 利用结果以及Compass-TC的接收是否会适应这些关系；和以下2 探索目的：探索目标1-检查社会，行为和功能性之间的关系 确定健康（作为Cossip-TC电子护理计划的一部分）和康复使用； 探索目的2-与基于索赔的数据相比，评估临床数据的额外好处 用迹象混淆。 这项研究的结果将填补我们对基于社区的使用和有效性的理解的空白 在“现实世界”护理的背景下进行康复，并将确定全面的有效性 过渡护理模型，改善了康复的访问/使用和中风生存的结果。 随着越来越多的人在中风，随着美国医疗保健系统的移动，信息至关重要 迈向基于价值的护理交付（例如，捆绑付款，负责任的护理组织，过渡护理）。