Stroke care - A method for measuring compliance with AHCPR guidelines

The purpose of this article is to describe a method for converting practice guidelines to measurement criteria. To evaluate the processes of care rece ived by patients with stroke at 11 Veteran's Administration hospital sites, we developed a measurement system based on Agency for Health Care Policy a nd Research (AHCPR) Post-Stroke Rehabilitation Clinical Practice Guidelines . Guideline recommendations were used as the framework for identifying impo rtant dimensions of care, and for developing chart abstraction instruments for both the acute and postacute settings. Using a modified Delphi techniqu e to solicit opinions from an expert panel, a method was developed for aggr egation of item-level chart abstraction components to overall guideline com pliance scores. The measurement system was shown to have good-to-excellent intrarater and interrater reliability at the item, dimension, and overall c ompliance score levels. Abstraction of a sample of 100 medical records demo nstrated the ability of the instruments to detect variability in processes of post-stroke care. This study provides the foundation for future research , which will evaluate associations between processes of post-stroke care, a s measured by this medical chart abstraction system, and patient outcomes. (All abstraction instruments, criteria, and scoring algorithms described in this article are available for download at http://www2.kumc.edu/coa.)