Communicative Access Measures for Stroke: Development and Evaluation of a Quality Improvement Tool

Publication date: Available online 20 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Aura Kagan, Nina Simmons-Mackie, J. Charles Victor, Melodie T.Y. Chan
Objective1) To develop a systems level quality improvement tool targeting communicative access to information and decision-making for stroke patients with language disorders and 2) to evaluate the resulting tool – Communicative Access Measures for Stroke (CAMS).DesignSurvey development and evaluation was in line with accepted guidelines, and included item generation and reduction, survey formatting and composition, pre-testing, pilot-testing, and reliability assessment.SettingDevelopment and evaluation were carried out in hospital and community agency settings.ParticipantsThe project utilized a convenience sample of 31 participants for the survey development, and 63 participants for the CAMS reliability study (broken down into 6 administrators/managers, 32 frontline staff, 25 participants with aphasia). The number of eligible participants invited to the reliability study included 45 community-based organizations in Ontario as well as 4400 individuals from communities of practice.InterventionsNot applicable.Main Outcome Measure(s)Data were analyzed using kappa statistics and intraclass correlations for each item score on all surveys.ResultsA tool, the Communicative Access Measures for Stroke (CAMS), comprising three surveys, was developed for health facilities from the perspectives of 1) administrators/policy makers, 2) staff/frontline health care providers, and 3) patients with aphasia (using a communicatively accessible version). Reliability for items on the CAMS Administrator and CAMS Staff surveys was moderate to high (Kappa/ICCs ranging from 0.54 to 1.00). As expected, reliability was lower for the CAMS Patient survey with most items having ICCs between 0.4 and 0.6.Conclusion(s): These findings suggest that CAMS may provide useful quality improvement information for health care facilities with an interest in improving care for patients with stroke and aphasia.



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