Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia.
Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North, Brisbane, Australia.
Health Expect. 2024 Oct;27(5):e14173. doi: 10.1111/hex.14173.
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) operationalise and (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 through a 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 to assessment (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 information and provision of therapy.
Our 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficient and 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 explored the 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. We received support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre.
目前，针对脑卒中后失语症服务，尚无达成一致的质量标准。因此，我们无从得知这些服务是否符合最佳实践，或者是否满足失语症患者的期望。本研究旨在：(1) 精选，(2) 操作化和 (3) 为脑卒中后失语症护理的最佳实践建议确定优先级。
本研究共分为三个阶段。在第一阶段，我们通过两轮电子德尔菲法，确定了具有强有力证据且/或对有过失语症经历的患者至关重要的建议。患者和卫生专业人员通过两轮电子德尔菲法对每条建议的重要性进行了评分。之后，每条建议都根据重要性和可行性进行了排名，并通过基于图论的投票系统进行了分析。在第二阶段，第一阶段中精选的建议被转化为质量指标，用于共识会议的评估和投票。在第三阶段，患者和卫生专业人员通过讨论和匿名投票，确定了实施的优先级。
在第一阶段，26 名有过失语症经历的患者和 81 名卫生专业人员对 23 条最佳实践建议进行了评价和评分，10 条建议被精选出来。在第二阶段，4 名有过失语症经历的患者和 17 名卫生专业人员就 11 条质量指标达成共识，这些指标涉及评估(2 条)、信息提供(3 条)、交流伙伴培训(3 条)、目标设定(1 条)、以患者和家庭为中心的护理(1 条)和治疗提供(1 条)。在第三阶段，5 名有过失语症经历的患者和 7 名卫生专业人员确定了三个实施优先级：失语症评估、提供易于理解的失语症信息和提供治疗。
我们的 11 条质量指标和 3 个实施优先级是在脑卒中后失语症服务中实现系统、高效和以患者为中心的测量和质量改进的第一步。质量指标将嵌入常规数据收集系统，并且还将制定策略来解决实施优先级。
本研究方案的制定参考了我们之前的研究，该研究探讨了 23 名有过失语症经历的患者对最佳失语症服务的看法。有过失语症经历的患者作为专家小组成员参加了我们的三次共识会议。我们还得到了与失语症康复和恢复卓越研究中心和昆士兰失语症研究中心相关的消费者咨询网络的支持。
