Highlights
- •Comprehensive Postacute Stroke Services (COMPASS) is a large pragmatic trial of comprehensive postacute stroke services.
- •The Movement Matters Activity Program (MMAP) is a key COMPASS model intervention.
- •The MMAP promotes evidence-based poststroke rehabilitative care in the community.
- •The MMAP implementation in home health and outpatient therapy was highly variable.
- •Keys to success: empowered leaders, informed clinicians, value-based care emphasis.
Abstract
The purpose of this Special Communication is to discuss the rationale and design of
the Movement Matters Activity Program for Stroke (MMAP) and explore implementation
successes and challenges in home health and outpatient therapy practices across the
stroke belt state of North Carolina. MMAP is an interventional component of the Comprehensive
Postacute Stroke Services Study, a randomized multicenter pragmatic trial of stroke
transitional care. MMAP was designed to maximize survivor health, recovery, and functional
independence in the community and to promote evidence-based rehabilitative care. MMAP
provided training, tools, and resources to enable rehabilitation providers to (1)
prescribe physical activity and exercise according to evidence-based guidelines and
programs, (2) match service setting and parameters with survivor function and benefit
coverage, and (3) align treatment with quality metric reporting to demonstrate value-based
care. MMAP implementation strategies were aligned with the Expert Recommendations
for Implementing Change project, and MMAP site champion and facilitator survey feedback
were thematically organized into the Consolidated Framework for Implementation Research
domains. MMAP implementation was challenging, required modification and was affected
by provider- and system-level factors. Program and study participation were limited
and affected by practice priorities, productivity standards, and stroke patient volume.
Sites with successful implementation appeared to have empowered MMAP champions in
vertically integrated systems that embraced innovation. Findings from this broad evaluation
can serve as a road map for the design and implementation of other comprehensive,
complex interventions that aim to bridge the currently disconnected realms of acute
care, postacute care, and community resources.
Graphical abstract
Graphical Abstract
Keywords
List of abbreviations:
APP (Advanced Practice Provider), CFIR (Consolidated Framework for Implementation Research), COMPASS (Comprehensive Postacute Stroke Services), COMPASS-CP (Comprehensive Postacute Stroke Services Care Plan), CMS (Centers for Medicare and Medicaid Services), EBP (evidence-based practice), MMAP (Movement Matters Activity Program), PAC (postacute care), TC (transitional care), TIA (transient ischemic attack)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 22, 2020
Footnotes
Supported by the Patient-Centered Outcomes Research Institute (PCORI) Project Program Award (no. PCS-1403-14532). All statements in this presentation, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or its Methodology Committee.
Clinical Trial Registration No.: NCT0258866.
Disclosures: Drs Duncan, Bushnell, and D'Agostino report ownership interest in Care Directions Inc. The other authors have nothing to disclose.
Identification
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© 2020 by the American Congress of Rehabilitation Medicine
