Implementing a Standardized Language Evaluation in the Acute Phases of Aphasia: Linking Evidence-Based Practice and Practice-Based Evidence.

The research to practice gap is a significant problem across all disciplines of healthcare. A major challenge associated with the adoption of evidence into routine clinical care is the disconnect between findings that are identified in a controlled research setting, and the needs and challenges of a real-world clinical practice setting. Implementation Science, which is the study of methods to promote research into clinical practice, provides frameworks to promote the translation of findings into practice. To begin to bridge the research-practice gap in assessing recovery in individuals with aphasia in the acute phases of recovery following stroke, clinicians in an acute care hospital and an inpatient rehabilitation hospital followed an implementation science framework to select and implement a standardized language assessment to evaluate early changes in language performance across multiple timepoints. Using a secure online database to track patient data and language metrics, clinically-accessible information was examined to identify predictors of recovery in the acute phases of stroke. We report on the feasibility of implementing such standardized assessments into routine clinical care via measures of adherence. We also report on initial analyses of the data within the database that provide insights into the opportunities to track change. This initiative highlights the feasibility of collecting clinical data using a standardized assessment measure across acute and inpatient rehabilitation care settings. Practice-based evidence may inform future research by contributing pilot data and systematic observations that may lead to the development of empirical studies, which can then feed back into clinical practice.

Implementing a Standardized Assessment Battery for Aphasia in Acute Care.

In this article, the implementation of a standardized assessment battery for the evaluation of language in an acute care setting is described. Following an institutional shift to adopt electronic medical records, researchers and clinicians worked together to develop a technology-assisted evaluation of aphasia that would be used to assess all patients admitted to our facility with stroke. The project goal was to devise a clinical process to improve aphasia diagnosis and evaluation while remaining feasible within constraints imposed by the acute care setting and the electronic medical record. Utilizing frameworks from implementation science, the four key phases were: (1) initial considerations of the host setting, (2) creation of a structure for implementation, (3) maintenance of this structure once implementation began, and (4) improvement for future applications. A pilot implementation demonstrated that establishing and executing a minimum standardized assessment for aphasia in acute care is feasible. Retrospective medical record review of 50 aphasia evaluations in the setting of first incidence of left hemisphere stroke affecting the middle cerebral artery (25 preimplementation and 25 postimplementation) revealed that information content of medical notes was more consistent and complete postimplementation than preimplementation. Clinical implications and future directions are discussed.