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Scale measures quality of hospital discharge process
Brief questionnaire is valid
Researchers have developed various tools to give discharge planners and physicians objective ways to determine whether patients are ready to be discharged from the hospital to home.
One new tool, called B-PREPARED scale, provides a brief, but thorough system of measuring a patient's readiness.
The new tool is based on a scale developed by Karen Grimmer-Somers, PhD, associate professor, Centre for Allied Health Research, University of South Australia, North Tce, Adelaide, Australia.1
The B-PREPARED scale was administered one week after discharge and can be used to evaluate a hospital's discharge interventions and for quality improvement efforts.
"Dr. Grimmer and her group had done focus groups to get down the qualities that would measure what we value," says James F. Graumlich, MD, FACP, associate professor of medicine and clinical pharmacology and interim chair in the department of medicine at the University of Illinois College of Medicine in Peoria, IL.
"But the scoring system wasn't optimal for what we wanted to use in our particular research," Graumlich notes. "If there was no response, it would give a missing response score, and that turns out to be problematic when doing statistics, so we changed the scoring response system."
For example, in the original scoring system, if a person was asked whether he or she received information about medication side effects and had no response because he or she wasn't sent home with any medication, then the person would be missing points on that question, Graumlich explains.
"In our system, that person would be considered satisfied and would get the highest score," he adds.2,3
When Graumlich and co-investigators validated their new scoring system in the study patient cohort, they found that the new scoring system discriminated very well between patients who did well after discharge and those who did not do well and returned for emergency department (ED) visits.
"It also correlated with whether patients were satisfied with the information they received about medications," Graumlich says.
The recent study also showed that the Australian questionnaire, which was developed for patients over 65 years, was valid for people who are at high risk and younger than 65 years, Graumlich says.
"Certain people who are younger have a lot of readmissions for diseases like HIV infection, sickle disease, multiple sclerosis, and others, and we didn't want to exclude those people," he explains.
The 11-item B-PREPARED scale includes such questions as "Before you were discharged from hospital, was there any other information you would have liked while you were in the hospital to prepare you for coping at home?"2
There are at least 15 frequently used standard assessment tools available for nurses, therapists, and social workers, including the Functional Independence Measure (FIM), the Mini Mental Scale, the Elderly Mobility Scale (EMS), and others.1
And there are survey instruments designed specifically for hospital discharge, including the Readiness for Hospital Discharge Scale and Care Transitions Measures, Graumlich notes.
One advantage of the B-PREPARED tool is that it is among the shorter questionnaires, he says.
"The more questions you have, the less practical it becomes to administer to people and to get them to answer all the questions," Graumlich says. "One of the choices we made in our design was to make the scale practical to see if we could get meaningful information out of a shorter questionnaire."
Hospitals that discover a problem with their discharge process through their more general patient satisfaction surveys might want to use the B-PREPARED instrument to pinpoint what those problems are, he suggests.
1. Informing discharge plans. Assessments of elderly patients in Australian public hospitals: a field study. Internet J Allied Healt Sci & Pract. 2004;2(3):1-15. Available at http://ijahsp.nova.edu/articles/Vol2number3/Grimmer-Discharge_Plans.htm.
2. Graumlich JF, Novotny NL, Aldag JC. Brief scale measuring patient preparedness for hospital discharge to home: psychometric properties. J Hosp Med. 2008;3(6):446-454.
3. Graumlich JF, Grimmer-Somers K, Aldag JC. Discharge planning scale: community physicians' perspective. J Hosp Med. 2008;3(6):455-464.
For more information, contact:
James F. Graumlich, MD, FACP, Associate Professor of Medicine and Clinical Pharmacology, Interim Chair, Department of Medicine, University of Illinois College of Medicine, 530 NE Glen Oak Avenue, Peoria, IL 61637. Telephone: (309) 655-7481.