Post-Acute Expenditures among Patients Discharged Home after Stroke or Transient Ischemic Attack: The COMprehensive Post-Acute Stroke Services (COMPASS) Trial

The COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic trial cluster-randomized 40 hospitals in North Carolina to the COMPASS transitional care (TC) post-acute care intervention or usual care. We estimated the difference in health care expenditures post-discharge for patients enrolled in the COMPASS-TC model of care compared to usual care. We linked data for patients with stroke or transient ischemic attack (TIA) enrolled in the COMPASS trial with administrative claims from Medicare fee-for-service (N=2,262), Medicaid (N=341), and a large private insurer (N=234). The primary outcome was 90-day total expenditures, analyzed separately by payer. Secondary outcomes were total expenditures 30- and 365-days post-discharge and, among Medicare beneficiaries, expenditures by point of service. In addition to intent-to-treat analysis, we conducted a per-protocol analysis to compare Medicare patients who received the intervention with those who did not, using randomization status as an instrumental variable. We found no statistically significant difference in total 90-day post-acute expenditures between intervention and usual care; the results were consistent across payers. Medicare beneficiaries enrolled in the COMPASS intervention arm had higher 90-day hospital readmission expenditures ($682, 95% CI [$60-$1305]), 30-day emergency department expenditures ($132, 95% CI [$13-$252]), and 30-day ambulatory care expenditures ($67, 95% CI [$38-$96]) compared to usual care. The per-protocol analysis did not yield a significant difference in 90-day post-acute care expenditures for Medicare COMPASS patients. The COMPASS-TC model did not significantly change patients' total healthcare expenditures for up to one-year post discharge.