HARMONICS: feasibility of a holistic value-based care hybrid programme that maximises clinical outcomes after stroke.

The HARMONICS programme met three of four predefined feasibility indicators across six comprehensive stroke centres.

• Feasibility thresholds required: inclusion >60%, 3-month retention >75%, PROMs completion >60%, and satisfaction >70% measured by PREM.
• Inclusion rate was 82.8% (exceeding the 60% threshold).
• Retention rate at 3 months was 84.6% (exceeding the 75% threshold).
• Satisfaction rate was 72.9% (exceeding the 70% threshold).
• PROMs completion at 90 days was 53.7%, which did not meet the predefined >60% threshold.

A total of 4209 stroke patients were recruited between 2022 and 2024 across six comprehensive stroke centres in Spain and Portugal.

• 40.2% of participants were women.
• Median age was 73 years (IQR 62–81).
• 75.6% had ischaemic stroke.
• Median admission NIHSS was 3 (IQR 1–6), indicating mild severity.
• Median discharge mRS was 2 (IQR 1–3).

HARMONICS patients showed a significantly better 3-month mRS distribution compared with historical controls.

• The comparison yielded OR 1.124 (95% CI, 1.042–1.213; P = .0026).
• PROMs were also improved compared with historical controls (P < .05).
• Secondary analyses compared outcomes with historical cohorts.

App-based follow-up was used by the majority of participants, with more than half using it independently.

• App use occurred in 59.9% of participants.
• 56% of those using the app did so independently.
• Follow-up was conducted via a smartphone app or telephone, enabling bidirectional communication with a case manager.

Despite mild stroke severity at discharge, many patients reported suboptimal patient-reported outcomes at 3 months, with only modest improvement by 1 year.

• Median discharge mRS was 2 (IQR 1–3) and median admission NIHSS was 3 (IQR 1–6), indicating overall mild severity.
• PROMs collection was integrated into the follow-up programme at multiple time points including 90 days and 1 year.
• PROMs improved modestly between 3 months and 1 year.

The HARMONICS programme used lean methodology to map post-stroke care pathways and implement a harmonised workflow integrating clinician-reported and patient-reported outcomes into a value-based care model.

• Post-stroke care pathways were mapped using lean methodology.
• The programme integrated clinician-reported outcomes measures (CROMs) and patient-reported outcomes measures (PROMs).
• Consecutive patients discharged home or to socio-rehabilitation facilities with an mRS <5 were offered participation.
• A case manager facilitated bidirectional communication for health education, vital sign monitoring, and PROMs collection.
• The programme was implemented across 6 comprehensive stroke centres in Spain and Portugal.