Impact of a Comprehensive Transitional Care Management Model on Use of Community‐Based Rehabilitation After Stroke

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Abstract
Background: Community‐based physical and occupational therapy (PT/OT) are critical for stroke recovery but are underused. We conducted a secondary analysis of the COMPASS (Comprehensive Post‐Acute Stroke Services) study, a pragmatic trial of comprehensive postacute transitional care (TC) to investigate whether TC programs increase PT/OT use. Methods: Forty hospitals were randomized to implement COMPASS‐TC or maintain usual care for patients with stroke/transient ischemic attack. In a crossover phase, usual care hospitals implemented COMPASS‐TC. We linked participants to administrative claims to assess PT/OT use after stroke. Adjusted generalized estimating equations compared COMPASS‐TC to usual care within the trial and crossover cohorts on 30‐/90‐day PT/OT use, time to first visit, number of visits, and receipt of PT and OT versus single therapy. Per protocol analysis estimated complier average causal effects. Results: COMPASS enrolled 8377 patients from July 2016 to March 2019; 5261 were linked to administrative claims. Thirty‐day PT/OT ranged from 22.6% in usual care to 37.5% in COMPASS‐TC. Therapy use was similar between groups in the trial cohort, and COMPASS‐TC was associated with increased use in crossover analysis (9.4% [95% CI, 5.6–13.3%] at 30 days). COMPASS‐TC was consistently associated with a shorter time to therapy (mean difference, −0.16 [95% CI, −0.03 to −0.29]). Per protocol results were larger for most outcomes. Conclusions: COMPASS‐TC was associated with shorter time to PT/OT and with greater therapy receipt in the crossover, but not the trial, analysis. Inconsistencies may reflect confounding or differences in hospitals that chose to adopt the intervention in Phase 2. Implementation studies to improve care transitions after stroke are needed to enhance use of postacute rehabilitation.

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