Establishing Quality Indicators and Implementation Priorities for Post-Stroke Aphasia Services Through End-User Involvement.

Abstract

Currently, there are no agreed quality standards for post-stroke aphasia services. Therefore, it is unknown if care reflects best practices or meets the expectations of people living with aphasia. We aimed to (1) shortlist, (2) operationaliseand (3) prioritise best practice recommendations for post-stroke aphasia care. Three phases of research were conducted. In Phase 1, recommendations with strong evidence and/or known to be important to people with lived experience of aphasia were identified. People with lived experience and health professionals rated the importance of each recommendation througha two-round e-Delphi exercise. Recommendations were then ranked for importance and feasibility and analysed using a graph theory-based voting system. In Phase 2,shortlisted recommendations from Phase 1 were converted into quality indicators for appraisal and voting in consensus meetings. In Phase 3,priorities for implementation were established by people with lived experience and health professionals following discussion and anonymous voting. In Phase 1, 23 best practice recommendations were identified and rated by people with lived experience (n = 26) and health professionals (n = 81). Ten recommendations were shortlisted. In Phase 2,people with lived experience (n = 4) and health professionals (n = 17) reached a consensus on 11 quality indicators, relating toassessment (n = 2), information provision (n = 3),communication partner training (n = 3),goal setting (n = 1),person and family-centred care (n = 1)and provision of treatment (n = 1). In Phase 3,people with lived experience (n = 5) and health professionals (n = 7) identified three implementation priorities: assessment of aphasia,provision of aphasia-friendly informationand provision of therapy. Our 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficientand person-centred measurement and quality improvement in post-stroke aphasia services. Quality indicators will be embedded in routine data collection systems, and strategies will be developed to address implementation priorities. Protocol development was informed by our previous research, which exploredthe perspectives of 23 people living with aphasia about best practice aphasia services. Individuals with lived experience of aphasia participated as expert panel members in our three consensus meetings. Wereceived support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre.