ArticleEuropean stroke journal2026
HARMONICS: feasibility of a holistic value-based care hybrid programme that maximises clinical outcomes after stroke.
Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe increasing number of stroke survivors underscores the need for coordinated post-discharge care and systematic outcome monitoring. HARMONICS aimed to provide standardised follow-up, integrating clinician-reported (CROMs) and patient-reported outcomes (PROMs) into a value-based care model. PATIENTS AND
methodsUsing lean methodology, post-stroke care pathways were mapped, and a harmonised workflow was implemented across 6 comprehensive stroke centres (CSCs) in Spain and Portugal. Consecutive patients discharged home or to socio-rehabilitation facilities with an mRS < 5 were offered participation. Follow-up was conducted via a smartphone app or telephone, enabling bidirectional communication with a case manager for health education, vital sign monitoring and PROMs collection. Feasibility required meeting 4 predefined indicators: inclusion > 60%, 3-month retention > 75%, PROMs completion > 60% and satisfaction > 70% measured by patient-reported experience measurement (PREM). Secondary analyses compared outcomes with historical cohorts.
resultsBetween 2022 and 2024, 4209 patients were recruited (40.2% women; median age 73 [IQR 62-81]; 75.6% ischaemic; median admission NIHSS 3 [1-6]; median discharge mRS 2 [1-3]). App use occurred in 59.9% (56% independently). Feasibility was achieved for inclusion (82.8%), retention (84.6%) and satisfaction (72.9%), but PROMs completion was 53.7% at 90 days. Despite mild severity, many reported suboptimal PROMs at 3 months, improving modestly by 1 year. Compared with historical controls, HARMONICS patients showed a better 3-month mRS distribution (OR 1.124; 95% CI, 1.042-1.213; P = .0026) and improved PROMs (P < .05). DISCUSSION AND
conclusionHARMONICS is a feasible multicentre value-based follow-up model that promotes education, engagement and self-responsibility, with high rates of healthcare satisfaction reported by stroke survivors.
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