A DISCHARGE PLANNING QUESTIONNAIRE FOR CLINICAL-PRACTICE

Each year more than one third of persons age 65 or over are hospitalized (National Center for Health Statistics, 1991). With lengths of hospital stays averaging 6.3 days, health care professionals have less time in which to identify older persons' needs for follow-up care and less time in which to arrange for care (National Center for Health Statistics, 1991). In fact, practitioners report that discharge planning rarely occurs smoothly; often assessments are incomplete, and the information needed for successful discharge planning is not recorded (Proctor & Morrow-Howell, 1990;Waters, 1980). Determining patients' and family members' perspectives of their situation and their needs is an important component of a comprehensive nursing assessment-one that is vital for effective discharge planning. Existing discharge screens focus on information such as patient's age, diagnosis, and living arrangements with little or no attention to patient or family expectations (Berkman & Abrams, 1986;Wallace & Steinhauer, 1988). The CAAST (continence, age, ambulation, social background, and thought [processes]) is one of the few objective clinical measures developed to assess patient's posthospital needs. The CAAST scale is based on the patient's status of continence, age, ambulation, social background, and thought processes. Scores for each category range from 0, indicating no problem in an area, to 2, reflecting persistent problems. Composite scores range from 0 to 10, with higher scores implying more complex needs after hospitalization (Glass & Weiner, 1976). However, Inui and colleagues (1981) reported that the CAAST identified only 63% of patients who require special arrangements for discharge placement. Although broad diagnostic and demographic screening criteria are widely used in practice situations, investigators indicate that these criteria have not been effective in identifying persons who need follow-up care (Berkman & Abrams, 1986). Previous screens for discharge planning were developed for use exclusively by professionals and tended to communicate factual information such as age, diagnosis, living arrangements, and previous hospitalizations (Matz & Berke, 1986). More recent screens emphasize patient functioning, availability of support, and some aspects of their physical environment (Berkman & Abrams, 1986;Wallace & Steinhauer, 1988). Less attention has been given to systematic ways of eliciting patients' and family members' perspectives and expectations about posthospital care and identifying discrepancies between facts, beliefs, and expectations. Because a measure for patient's expectations and perspectives on their needs for posthospital care could not be found, the Discharge Planning Questionnaire (DPQ) was developed to aid clinicians in identifying patients' and family members' perspectives on their needs for follow-up care. © 1994.