Academic journal article Social Work Research

The English Translation and Testing of the Problems after Discharge Questionnaire

Academic journal article Social Work Research

The English Translation and Testing of the Problems after Discharge Questionnaire

Article excerpt

The quality of hospital discharge planning assessments determines whether patients receive the health and social services they need or are sent home with unmet needs and without services. There is a valid and reliable Dutch instrument that measures problems and unmet needs patients encounter after discharge. This article describes the translation and testing of the English version of the Problems after Discharge Questionnaire for use in evaluating hospital discharge planning. Internal consistency reliability of multiple item subscales was assessed with Cronbach's alpha (>.70 for four of six subscales where alpha could be computed [two others were single items only]). Subscales were correlated with similar constructs corresponding to the same problem areas in the theoretical model. The goal was to use the questionnaire with English-speaking patients to capture a comprehensive picture of physical, social, and psychological problems and unmet needs that patients encounter after hospital discharge.

KEY WORDS: care transition; hospital discharge; postacute care; Problems after Discharge Questionnaire; validity and reliability


Hospital discharge planning is the primary vehicle for managing care transitions from the hospital to the next setting. Discharge planning is a process that includes identifying and anticipating patients' postacute care needs and developing and implementing a plan to address those (Zwicker & Picariello, 2003). People at risk for adverse outcomes after discharge often have multiple health, functional, and social care needs (Coleman, 2003). Adverse outcomes related to hospital discharge planning have also been linked to unidentified and, therefore, unmet continuing care needs (Mistiaen, Francke, & Poot, 2007).

Care needs may be informational (appropriate levels of physical activity, side effects of medications, where and how to get help), functional (showering or bathing, dressing and undressing, preparing meals), physical (pain, unsteadiness, sleeping), emotional (restlessness, sadness, anxiety), or social (isolation, lack of support). A quality discharge plan occurs when the plan identifies all existing and potential continuing care needs, and a quality discharge occurs when the mechanisms for addressing the needs are implemented as planned (Bull & Roberts, 2001; Morrow-Howell, Proctor, & Dore, 1998). Two reviews of the discharge planning literature indicated a focus on the hospital aspect of sending patients to the next setting (Hedges, Grimmer, Moss, & Falco, 1999; Shepperd et al., 2011). Only two instruments were found that are designed specifically to measure quality of care transitions and discharge planning interventions from the perspective of the patient: the Care Transitions Measure (Coleman et al., 2002) and the Problems after Discharge Questionnaire (Mistiaen, Duijnhouwer, Wijkel, de Bont, & Veeger, 1997).

The CareTransitions Measure was developed as a patient-centered measure to assess the overall quality of care transitions across health care settings (Coleman et al., 2002). The Three-Item Care Transitions Measure (CTM-3) has recently been endorsed by the National Quality Forum (2006) as a voluntary consensus standard for measuring quality coordination of hospital discharge care. Although the CTM-3 provides an abbreviated understanding of quality of coordination in the discharge planning process from the patient's perspective, it does not address key continuing care needs of recently hospitalized patients found in the discharge planning literature (for example, physical, functional, emotional).

The Problems after Discharge Questionnaire (PADQ) is a Dutch instrument that has been developed, tested, and used in discharge planning research in the Netherlands (Borer, Mistiaen, Duijnhouwer, & Groenewegen, 1998; Borer, Mistiaen, & Groenewegen, 2000; Duijnhouwer & Mistiaen, 1999; Mistiaen et al. …

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