Trial reportThe Gerontologist2020
Implementation of a Transitional Care Model for Stroke: Perspectives From Frontline Clinicians, Administrators, and COMPASS-TC Implementation Staff.
Trial report in The Gerontologist, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02588664 (Early Supported Discharge for Improving Functional Outcomes After Stroke), which is not on this map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Early Supported Discharge for Improving Functional Outcomes After Stroke
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Implementation Outcomes and Their Determinants for Hospital-Led Care Coordination Interventions Targeting Patients With Complex Care Needs: A Qualitative Systematic Review.Journal of clinical nursing · 2026Pooled it
- The Effectiveness of Nurse-Led Transition Care on Post-Discharge Outcomes of Adult Stroke Survivors: A Systematic Review and Meta-Analysis.Nursing open · 2025Pooled it
- Hospital Readmissions and Mortality Among Fee-for-Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster-Randomized Pragmatic Trial.Journal of the American Heart Association · 2021Trial
- Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives.BMC health services research · 2021Trial
- The Impact of a Video-Educational and Tele-Supporting Program on the Caregiver-Stroke Survivor Dyad During Transitional Care (D-STEPS: Dyadic Support Through Tele-Health and Educational Programs in Stroke Care): A Longitudinal Study Protocol.Healthcare (Basel, Switzerland) · 2025Article
- Context and determinants for implementing a sepsis survivor care transition intervention reported from five health systems and home health agencies.Frontiers in medicine · 2025Article
- Transforming Posthospital Stroke Care, Outcomes, and Use of New Innovations Through Implementation Science.Journal of the American Heart Association · 2024Article
- Facilitating and barrier factors to the implementation of a transitional care program: a qualitative study of hospital coordinators in South Korea.BMC health services research · 2024Article
- Systematic development of a set of implementation strategies for transitional care innovations in long-term care.Implementation science communications · 2023Article
- Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review.Healthcare (Basel, Switzerland) · 2023Article
- Implementing Four Transitional Care Interventions for Older Adults: A Retrospective Collective Case Study.The Gerontologist · 2023Article
- Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique.BMC geriatrics · 2022Article
- Challenges and Facilitators in Implementing a Focus on Function in Structured Clinical Settings.The Public policy and aging report · 2022Article
- Implementation of the virtual transitional care stroke intervention for older adults with stroke and multimorbidity: A qualitative descriptive study.Journal of multimorbidity and comorbidityArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
objectivesStroke is a chronic, complex condition that disproportionally affects older adults. Health systems are evaluating innovative transitional care (TC) models to improve outcomes in these patients. The Comprehensive Post-Acute Stroke Services (COMPASS) Study, a large cluster-randomized pragmatic trial, tested a TC model for patients with stroke or transient ischemic attack discharged home from the hospital. The implementation of COMPASS-TC in complex real-world settings was evaluated to identify successes and challenges with integration into the clinical workflow. RESEARCH DESIGN AND
methodsWe conducted a concurrent process evaluation of COMPASS-TC implementation during the first year of the trial. Qualitative data were collected from 4 sources across 19 intervention hospitals. We analyzed transcripts from 43 conference calls with hospital clinicians, individual and group interviews with leaders and clinicians from 9 hospitals, and 2 interviews with the COMPASS-TC Director of Implementation using iterative thematic analysis. Themes were compared to the domains of the RE-AIM framework.
resultsOrganizational, individual, and community factors related to Reach, Adoption, and Implementation were identified. Organizational readiness was an additional key factor to successful implementation, in that hospitals that were not "organizationally ready" had more difficulty addressing implementation challenges. DISCUSSION AND IMPLICATIONS: Multifaceted TC models are challenging to implement. Facilitators of implementation were organizational commitment and capacity, prioritizing implementation of innovative delivery models to provide comprehensive care, being able to address challenges quickly, implementing systems for tracking patients throughout the intervention, providing clinicians with autonomy and support to address challenges, and adequately resourcing the intervention. CLINICAL
trial registrationNCT02588664.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.