Advertisement

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

      Abstract

      Objectives

      To (1) develop a systems-level quality improvement tool targeting communicative access to information and decision-making for stroke patients with language disorders; and (2) evaluate the resulting tool—the 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, pretesting, pilot testing, and reliability assessment.

      Setting

      Development and evaluation were carried out in hospital and community agency settings.

      Participants

      The project used 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). Eligible participants invited to the reliability study included individuals from 45 community-based organizations in Ontario as well as 4400 individuals from communities of practice.

      Interventions

      Not applicable.

      Main Outcome Measures

      Data were analyzed using kappa statistics and intraclass correlations for each item score on all surveys.

      Results

      A tool, the CAMS, comprising 3 surveys, was developed for health facilities from the perspectives of (1) administrators/policymakers, (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/intraclass correlation coefficients [ICCs], .54–1.00). As expected, reliability was lower for the CAMS-Patient survey, with most items having ICCs between 0.4 and 0.6.

      Conclusions

      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.

      Keywords

      List of abbreviations:

      CAMS (Communicative Access Measures for Stroke), ICC (intraclass correlation coefficient)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organization
        International classification of functioning, disability and health: ICF.
        World Health Organization, Geneva2001
        • United Nations
        UN convention on the rights of persons with disabilities. Final report of the Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities.
        (Available at:) (Accessed June 15, 2016)
        • The Joint Commission
        Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. Oakbrook Terrace: The Joint Commission.
        (Available at:) (Accessed Jul 27, 2016)
      1. Health Care Consent Act of 1996, S.O. 1996, c. 2, Sched. A.
        (Available at:) (Accessed July 19, 2016)
      2. Substitute Decisions Act of 1992, S.O. 1992, c. 30.
        (Available at:) (Accessed July 19, 2016)
        • Dickey L.
        • Kagan A.
        • Lindsay M.P.
        • Fang J.
        • Rowland A.
        • Black S.
        Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.
        Arch Phys Med Rehabil. 2010; 91: 196-202
        • Howe T.
        • Worrall L.
        • Hickson L.
        Review.
        Aphasiology. 2004; 18: 1015-1037
        • Kagan A.
        Supported Conversation for Adults with Aphasia: methods and resources for training conversation partners.
        Aphasiology. 1998; 12: 816-830
        • Kagan A.
        • Black S.E.
        • Duchan J.F.
        • Simmons-Mackie N.
        • Square P.
        Training volunteers as conversation partners using “Supported Conversation for Adults with Aphasia” (SCA) a controlled trial.
        J Speech Lang Hear Res. 2001; 44: 624-638
        • Kagan A.
        • LeBlanc K.
        Motivating for infrastructure change: toward a communicatively accessible, participation-based stroke care system for all those affected by aphasia.
        J Commun Disord. 2002; 35: 153-169
        • O'Halloran R.
        • Grohn B.
        • Worrall L.
        Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: a qualitative metasynthesis.
        Arch Phys Med Rehabil. 2012; 93: S77-S85
        • Simmons-Mackie N.N.
        • Kagan A.
        • O'Neill Christie C.
        • Huijbregts M.
        • McEwen S.
        • Willems J.
        Communicative access and decision making for people with aphasia: implementing sustainable healthcare systems change.
        Aphasiology. 2007; 21: 39-66
      3. Simmons-Mackie N. King J.M. Beukelman D.R. Supporting communication for adults with acute and chronic aphasia. Paul H. Brookes, Baltimore2013
        • Simmons-Mackie N.
        • Raymer A.
        • Armstrong E.
        • Holland A.
        • Cherney L.R.
        Communication partner training in aphasia: a systematic review.
        Arch Phys Med Rehabil. 2010; 91: 1814-1837
        • Simmons-Mackie N.
        • Raymer A.
        • Cherney L.R.
        Communication partner training in aphasia: an updated systematic review.
        Arch Phys Med Rehabil. 2016; 97: 2202-2221
        • Lomas J.
        • Pickard L.
        • Bester S.
        • Elbard H.
        • Finlayson A.
        • Zoghaib C.
        The Communicative Effectiveness Index: development and psychometric evaluation of a functional communication measure for adult aphasia.
        J Speech Hear Disord. 1989; 54: 113-124
        • Long A.
        • Hesketh A.
        • Bowen A.
        Communication outcome after stroke: a new measure of the carer's perspective.
        Clin Rehabil. 2009; 23: 846-856
        • Simmons-Mackie N.
        Frameworks for managing communication support for people with aphasia.
        in: Simmons-Mackie N. King J. Beukelman D.R. Supporting communication for adults with acute and chronic aphasia. Paul H. Brookes, Baltimore2013
      4. The Aphasia Institute.
        (Available at:)
        www.aphasia.ca
        Date: 2015
        (Accessed June 15, 2016)
      5. Aphasia United. Best practice recommendations for aphasia.
        (Available at:) (Accessed July 27, 2016)
      6. Hebert D, Teasell R, on behalf of the Stroke Rehabilitation Writing Group. In: Lindsay MP, Gubitz G, Bayley M, Smith EE, editors, on behalf of the Canadian Stroke Best Practices Advisory Committee. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, 2015. Ottawa, Ontario Canada: Heart and Stroke Foundation. Available at: http://www.strokebestpractices.ca/index.php/stroke-rehabilitation/. Accessed June 22, 2017.

        • Hebert D.
        • Lindsay M.P.
        • McIntyre A.
        • et al.
        Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015.
        International Journal of Stroke. 2016; 11: 459-484
        • Simmons-Mackie N.
        • Worrall L.
        • Murray L.
        • et al.
        The top ten: best practice recommendations for aphasia.
        Aphasiology. 2016; 31: 131-151
        • Norman G.R.
        • Streiner D.L.
        3rd Ed. PDQ statistics. People's Medical Publishing House, Shelton, CT2003
      7. The Beryl Institute.
        (Available at:) (Accessed June 15, 2016)
        • Groene O.
        Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation.
        Int J Qual Health Care. 2011; 23: 531-537