Abstract NS1: Development of the Preparedness Assessment for the Transition Home After Stroke (PATH-s) Instrument

Abstract

Introduction: Care transitions from the inpatient rehabilitation facility (IRF) to home after stroke are often ineffective and inefficient, resulting in unmet patient and caregiver needs, increased safety risks, high rates of preventable readmissions, and increased health care costs. There is no assessment instrument specifically designed to evaluate caregiver readiness for this transition. The purpose of this study is to describe the development of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) instrument. Methods: A cross-sectional study was conducted to establish the psychometric properties of the PATH-s instrument using a convenience sample of 60 caregivers of stroke patients with moderate to severe impairment during IRF admission. A sequential, multi-method approach to instrument development beginning with item generation from qualitative research findings followed by (a) review of items by expert case managers, (b) development of an alternative Likert format, (c) selection of the format that provides greatest clarity, and (d) cognitive appraisal interviews with caregivers with associated instrument revision was used to develop a measure of readiness for the transition from IRF to home for stroke caregivers. Results: The novel PATH-s instrument is a 15-item, 4-point scale that has demonstrated validity. Next steps include additional psychometric testing of the PATH-s to understand the predictive validity to stratify the degree of risk of adverse health effects for stroke survivors and caregivers following transition from the IRF to home. Conclusion: The PATH-s may support a primary prevention strategy to identify gaps in preparedness for stroke survivor-caregiver dyads during this high risk transition, with the long-range goal to mitigate the effects of suboptimal preparation and the associated adverse effects associated with this transition on the health of stroke survivor and caregiver. Once gaps are identified, care plans can be tailored to address gaps and better prepare caregivers for the transition home. This optimized approach to transitions management will address the National Quality Strategy “Triple Aim” to improve quality of care, improve health, and reduce costs for the care delivery system.