Discharge care quality in hospitalised elderly patients: Extended validation of the Discharge Care Experiences Survey

Abstract

BackgroundThe Discharge Care Experiences Survey (DICARES) was previously developed to measure quality of discharge care in elderly patients (≥ 65 years). The objective of this study was to test the factorial validity of responses of the DICARES, and to investigate its association with existing quality indicators.MethodsWe conducted a cross-sectional study at two hospitals in Bergen, Western Norway. A survey, including DICARES, was sent by postal mail to 1,418 patients 30 days after discharge from hospital. To test the previously identified three-factor structure of the DICARES we applied a first order confirmatory factor analysis with corresponding fit indices and reliability measures. Spearman’s correlation coefficients, and linear regression, was used to investigate the association of DICARES scores with the quality indicators Nordic Patient Experiences Questionnaire and emergency readmission within 30 days.ResultsA total of 493 (35%) patients completed the survey. The mean age of the respondents was 79 years (SD = 8) and 52% were women. The confirmatory factor analysis showed acceptable fit. Cronbach’s α between items within factors was 0.82 (Coping after discharge), 0.71 (Adherence to treatment), and 0.66 (Participation in discharge planning). DICARES was moderately correlated with the Nordic Patient Experiences Questionnaire (rho = 0.49, P < 0.001). DICARES overall score was higher in patients with no readmissions compared to those who were emergency readmitted within 30 days (P < 0.001), indicating that more positive experiences were associated with fewer readmissions.ConclusionsDICARES appears to be a feasible instrument for measuring quality of discharge care in elderly patients (≥ 65 years). This brief questionnaire seems to be sensitive with regard to readmission, and independent of comorbidity. Further studies of patients’ experiences are warranted to identify elements that impact on discharge care in other patient groups.

Measuring discharge quality based on elderly patients’ experiences with discharge conversation: a cross-sectional study

“…Similar to a previous study on the DICARES-M,23 24% of the patients in the current study experienced emergency readmission within 30 days after their hospitalisation (table 1). This is nearly double the percentage among 700 000 patients (mean age=78 years) in a large-scale study of hospital readmissions in Canada 42.…”

“…The participation in the discharge planning factor of the DICARES-M had the lowest scores (table 4), which is consistent with findings of a previously published study of the DICARES-M,23 and those of other studies of elderly patients’ discharge experiences 9 36 37. The lack of routines or procedures designed to make sure that patients’ opinions are heard might be a reason for this result 35.…”

“…We used a cross-sectional study design to evaluate patient experiences of discharge conversation in hospital by using two questionnaires: a modified version of the Discharge Care Experiences Survey (DICARES-M)23 and the Nordic Patient Experiences Questionnaire (NORPEQ), which is frequently used as a quality indicator in Norwegian hospitals 24 25…”

“…As quality in discharge cannot be measured by one singular question, we applied a newly developed instrument, DICARES-M, with a sum score reflecting quality 8 23. The original first version of DICARES-M8 that contained 10 items was evaluated by healthcare professionals and adjusted by adding one item: I received information about the effects and side effects of my medication .…”

“…We included this item because medication errors are one of the most commonly reported adverse events after hospitalisation 26. The modified DICARES-M version23 contains 11 items in three factors: coping after discharge (4 items), participation in discharge planning (4 items) and adherence to treatment (3 items). Negative DICARES-M statements (seven items), such as I have experienced problems in understanding the instructions I received when I was discharged from the hospital, were inverted to a positive scale.…”