New reliable tool for evaluating the quality of hospital care for acute stroke

The newly developed "STROKE Perception Report" is a valid and reliable tool for evaluating the quality of hospital care for acute stroke, reports a study in the Journal of Neuroscience Nursing, official journal of the American Association of Neuroscience Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Focusing on the three most important areas identified by stroke patients and their families, the new survey provides hospitals with a "report card" on patient perceptions of the quality of acute stroke care. Anne W. Alexandrov, PhD, of PhD RN CCRN ANVP-BC NVRN-BC FAAN, of Health Outcomes Institute, LLC, and University of Tennessee Health Science Center is lead author of the new study.

New insights into patient and family ratings of quality of stroke care

The researchers describe the development and evaluation of the STROKE (Stroke Treatment, Risk, Outcome Knowledge, Education) Perception Report. In an initial qualitative study, they performed focus groups with patients hospitalized for disabling strokes and their families. On thematic analysis of those discussions, the researchers identified three themes "perceived as essential to the provision of high-quality acute stroke care":

• Fast Action to Diagnose and Treat Stroke. Participants described the importance of fast action by doctors and nurses to respond to stroke symptoms. They understood the critical importance of immediate treatment for stroke, such as the use of "clot-buster" drugs when indicated.
• Genuine Caring. Participants emphasized the importance of feeling genuinely cared for. They placed a high value on patience, respect, and kindness, engaged listening, and trust in caregivers.
• Education to Prevent and Respond to Future Strokes. Patients and families understood the importance of being knowledgeable about stroke and being prepared to prevent, recognize, and respond to future strokes. They appreciated providers' patience in teaching them about stroke warning signs, risk factors, and lifestyle changes to reduce risk.

Based on these three themes, Dr. Alexandrov and colleagues developed the 30-question survey. They performed a quantitative study including a diverse sample of more than 1,000 patients and their family members at 35 certified stroke centers across the United States. Patients/families completed the survey right before leaving the hospital, ensuring high survey return rates with the best possible recall of the hospital experience.

The results provided important statistics on the psychometric performance of the STROKE Perception Report, establishing its validity and reliability. The evaluation also highlighted the importance of the three themes-;which, taken together, explained most of the variation in patients' and families' ratings of the quality of acute stroke care. There were no significant differences in ratings by race/ethnicity or length of hospital stay.

Participating stroke centers received their survey results in the form of a "report card," which provided a snapshot of their quality ratings compared to other hospitals. In a final pilot study, most patients rated survey administration on an electronic pad format as easy to use and more confidential/private than a paper survey.

Patient and family perceptions of the quality of healthcare have become an important part of hospital quality measurements. Patients hospitalized for acute stroke are a "highly vulnerable" group, with high rates of disability at hospital discharge and significant needs for education to reduce risk and increase recognition of stroke symptoms/warning signs.

The new study shows that the STROKE Perception Report provides valuable insights into patients' and families' beliefs about the quality of acute stroke care- including two domains (fast action and education) not addressed by previous surveys. Dr. Alexandrov and coauthors conclude:

By understanding these important perceptions of acute stroke services through the eyes of stroke survivors and caregivers, stroke center hospitals are well positioned to improve and celebrate the care they deliver in support of this vulnerable patient population."