Abstract NS 1: S troke T reatment, R isk Factors, O utcome K nowledge and E ducation (STROKE) Perception Report: Final Results of the Prospective National Multicenter Validation Study of Instrument Validity and Reliability

Background: Measurement of patient perception of the quality of acute stroke care is an expectation for certified Stroke Centers, yet no valid and reliable instrument specific to the needs of stroke patients has been available for this purpose. We developed the STROKE Perception Report through a process consisting of 5 years of qualitative and quantitative research, culminating in a national prospective multi-center study and psychometric analysis. Methods: The final instrument was the product of 2 qualitative and 2 quantitative phases of study into the characteristics of acute stroke hospital care valued most by patients and families. The instrument consists of 39 items divided into 3 scales: Action to Diagnose and Treat Stroke; Caring; and Education to Prevent and Respond to Stroke. 35 study sites were recruited from the continental U.S. and Hawaii to participate in the study, with instrument testing commencing June 2010 and ending July 2011. Patients admitted with acute stroke completed the instrument unless disabled by cognitive, level of consciousness, or language dysfunction, whereby the family member with the most hospitalization exposure completed a family version of the instrument. Data were confidentially collected at the point of hospital discharge after all contact with hospital staff was complete, and entered and analyzed by investigators independent of participating institutions and blinded to the identity of each instrument’s originating hospital site. Analyses included Chronbach alpha internal consistency reliability, and exploratory factor analysis using principal components with varimax rotation for construct validity. Results: A total of 1029 completed instruments were received for analysis. Chronbach’s alpha scores ranged from .92 to .95 for the patient version and .92 to .94 for the family version of the instrument, demonstrating excellent reliability. Content validity was initially established by 5 panelists aware of the qualitative findings from phase 1 and 3 of the study, resulting in a content validity ratio of .99. Factor analysis testing indicated that each of the 3 scales within the instrument (Action to Diagnose and Treat Stroke; Caring; and Education to Prevent and Respond to Stroke) are capable of validly measuring their defined dimensions of patient/family perception, with factor loadings ranging from .63 to .89 for individual items overall. Individual Stroke Center reports that provide benchmark comparisons of patients’ perception of the quality of acute stroke services among participating hospitals were produced quarterly and resulted in positive feedback from program administrators and TJC PSC Reviewers during on-site certification visits. Conclusions: The STROKE Perception Report is the first and only valid and reliable instrument designed to capture both patients’ and family members’ perceptions of the quality of acute stroke services.