THE DEVELOPMENT AND IMPLEMENTATION OF A STANDARD ASSESSMENT BATTERY ACROSS THE CONTINUUM OF CARE FOR PATIENTS AFTER STROKE

P. Lien¹, K. Johnson¹, A. Lasner¹, D. Levine², P. Raghavan³

¹Johns Hopkins Medicine, Physical Medicine and Rehabilitation, Baltimore, United States, ²The University of Tennessee at Chattanooga, Physical Therapy, Chattanooga, United States, ³Johns Hopkins University, School of Medicine, Baltimore, United States

Background: Stroke rehabilitation occurs across the continuum of care starts in the acute hospital through the inpatient and outpatient settings. Rehabilitation aims to minimize impairments and maximize function in individuals after stroke. Since patients often undergo rehabilitation for extended periods of time, longitudinal assessment of impairment, activity and participation can facilitate the evaluation of patients’ progress toward recovery, as well as communication and decision making to guide clinical practice regarding the intervention(s) to be used, and may also be leveraged for clinical research.

Purpose: The clinical implementation of a standard assessment battery that spans the continuum of care for patients after stroke is challenging due to operational and time constraints. Here we describe the development and implementation of a standard assessment battery across the continuum of care by physical therapists, occupational therapists, and speech-language pathologists at the Sheikh Khalifa Stroke Institute (SKSI).

Methods: We specifically describe our experience in 1) identifying the core team to lead the process, 2) selecting the measures for the standard assessment battery, and the timeframe for administration, and 3) implementing the standard assessment battery in routine clinical practice.

Results: The SKSI team has successfully implemented the selected battery of outcome measures across the continuum. These outcome measures encompass the domains of impairments, function and participation for each discipline. The selection of measures and the timeframe for their administration had to be balanced with the need for completing the assessments while ensuring that there was adequate time to provide clinical care. Clinical care setting with varying length of stay required different compliance audit metrics.

Conclusions: A multidisciplinary team at the Johns Hopkins Sheikh Khalifa Stroke Institute developed and implemented a standard assessment battery for routine clinical administration across the continuum of rehabilitation. This process required partnerships between leadership, clinicians, informaticians, and researchers to ensure that the assessments selected were feasible, easily documented in the EHR, and useful for both clinical practice and research.

Implications: The goal of the standard assessment battery is to enhance the efficiency of clinical care by providing the right treatment for the right person at the right time. Using a standard assessment battery throughout the rehabilitation process can enable clinicians to track progress and guide treatment across the continuum of care. Furthermore, leveraging the existing clinical infrastructure such as the EHR for data entry and extraction for research can potentially advance our understanding of stroke recovery in the real world. Inter-institutional collaborations to pool the data to will pave the way for data-driven evidence-based precision rehabilitation.

Funding acknowledgements: The grant funding provided by United Arab Emirates Ministry of Health and the Johns Hopkins Sheikh Khalifa Stroke Institute

Keywords:
Stroke
Functional Outcomes
Continuum of care

Topics:
Neurology: stroke
Research methodology, knowledge translation & implementation science
Neurology

Did this work require ethics approval? Yes

Institution: Johns Hopkins Medicine

Committee: Institutional Review Board

Ethics number: 247292