REVIEW CRITERIA FOR STROKE REHABILITATION OUTCOMES

Objectives: To develop review criteria from the Agency for Health Care Policy and Research Stroke Rehabilitation Guidelines, to review chart records from three sites of care, and to evaluate the interrater and intrarater reliability for the chart review. Design: A descriptive cro ss-sectional study using a convenience sample. Setting: Charts for abs traction were obtained from three sites of care: home health care, nur sing facilities, and inpatient rehabilitation centers. Participants: C harts were included In the study from the three sites of care if the f ollowing conditions were met: (I) the: client's first admission to a r ehabilitation setting; (2) the client's care was Medicare reimbursed: (3) the client lived in the community prior to the stroke; and (4) the client was receiving skilled rehabilitation services. Measures: Revie w criteria, developed directly from the AHCPR Stroke Rehabilitation gu idelines, consisted of 11 global quality criteria representative of co mprehensive multidisciplinary rehabilitative care. There were approxim ately 150 variables, comprised of specific criteria to measure each of the 11 global quality criteria plus comprehensive demographic and cli ent-specific information.Results: Results of this study suggest that d ifferences exist in documentation of care across the three sites of ca re, There was difficulty in obtaining adequate numbers of home health charts. Intrarater reliability, using Cohen's Kappa, was .78 and inter rater reliability was .64. Conclusions: Based on chart documentation, there is variability in the process of stroke rehabilitation care acro ss nursing facilities, inpatient rehabilitation facilities, and home h ealth. This variability can be reliably assessed by chart review. This study provides the impetus for future research specifically evaluatin g the associations between documentation of the processes of care and patient outcomes. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitat ion.