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

## TL;DR

HARMONICS is a new care model for stroke survivors that improves outcomes through coordinated follow-up and patient engagement.

## Contribution

HARMONICS introduces a feasible hybrid care model integrating clinician and patient-reported outcomes for post-stroke follow-up.

## Key findings

- HARMONICS achieved high recruitment and retention rates across six stroke centers in Spain and Portugal.
- Patients in HARMONICS showed better 3-month mRS outcomes and improved PROMs compared to historical controls.
- Despite success in most metrics, PROMs completion at 90 days fell below the target threshold.

## Abstract

The 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.

Using 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.

Between 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).

HARMONICS 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.

Graphical Abstract