Abstract 3537: Patient and Family Perceptions of the Quality of Acute Stroke Services: Findings from a Multi-Center National Study of the STROKE Perception Report

Abstract

Background: The STROKE Perception Report is a valid and reliable instrument for assessment of patients’ and family members’ perceptions of the quality of acute stroke services. We examined differences in perceptions of acute stroke hospital care quality in relation to responder characteristics. Methods: As part of a psychometric analysis, data were collected from June 2010-July 2011 at 35 Stroke Centers in the continental U.S. and Hawaii. A special family instrument was used for patients with cognitive, level of consciousness, or communication issues that prevented direct patient response. Data collection occurred at the time of hospital discharge following completion of all interactions with hospital staff in a private area; surveys were sealed in de-identified envelopes once complete and submitted to independent investigators blinded to hospital sites for entry/analyses by Chi-square, Student’s t-test and logistic regression with SAS. RESULTS: A total of 1029 surveys were returned (761 [74%] patient, 268 [26%] family) with an overall complete response rate of 99.8%. Racial characteristics and ethnicity for the overall sample showed 72% white, 19% African American, 6% Asian, 2% Native Hawaiian/Pacific Islander and 1% American Indian/Alaska Native with 7% responding as Hispanic ethnicity. Education for the overall sample showed 87% of the participants graduated high school with 28% having a 4-year college degree or higher; higher educated family members were more likely to complete the survey (OR 1.178, 95% CI 1.045-1.328, p=0.0074). Length of stay (LOS) averaged 5%/-4.3 (range=1-59 days); the odds of family members acting as survey respondees was significantly associated with an increased LOS (OR 1.14, 95%CI 1.098-1.192, p<0.0001). There was no difference in the perception of care quality by race, ethnicity, or LOS. Lowest rated quality items overall were in the 'Education to Prevent and Respond to Stroke' scale, while the highest rated quality items were in the 'Caring' scale. Patients were more likely to express displeasure over the way nurses treated their family members (p<0.0001), and were more likely to state that their nurses (p=0.015) and physicians (p=0.0009) did not teach them about the warning signs for a stroke as compared to family member perceptions. Recall of educational content pertinent to stroke between patients and family members was different for facial droop (16% vs.8%; p= 0.001) and sudden onset of speech difficulty (11% vs. 5%; p= 0.016), with more patients stating these were not signs of stroke. People with a higher education were more likely to state that the nurses (p= 0.0014) and doctors (0.012) did not educate them about post-hospitalization care. Conclusions: The STROKE Perception Report provides insight into how patients and family members perceive the quality of acute stroke service, enabling ongoing performance improvement.