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

Abstract Objective 1) 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). Design Survey 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. Setting Development and evaluation were carried out in hospital and community agency settings. Participants The 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. Interventions Not applicable. Main Outcome Measure(s) Data were analyzed using kappa statistics and intraclass correlations for each item score on all surveys. Results A 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.