Department of Clinical Sciences, University of Bergen, Bergen, Norway.
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
PLoS One. 2019 Sep 26;14(9):e0223150. doi: 10.1371/journal.pone.0223150. eCollection 2019.
The 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.
We 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.
A 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.
DICARES 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.
先前开发了出院护理体验调查（DICARES），用于衡量老年患者（≥65 岁）的出院护理质量。本研究的目的是检验 DICARES 反应的因子有效性，并探讨其与现有质量指标的关联。
我们在挪威卑尔根的两家医院进行了一项横断面研究。在出院后 30 天，通过邮寄向 1418 名患者发送了一份包括 DICARES 的调查问卷。为了检验 DICARES 先前确定的三因素结构，我们应用了一阶验证性因子分析，并采用相应的拟合指数和可靠性测量方法。采用斯皮尔曼相关系数和线性回归分析，研究 DICARES 评分与质量指标北欧患者体验问卷（Nordic Patient Experiences Questionnaire）和 30 天内急诊再入院之间的关系。
共有 493 名（35%）患者完成了调查。受访者的平均年龄为 79 岁（标准差=8），52%为女性。验证性因子分析显示拟合度可接受。各因子内项目之间的克朗巴赫α值为 0.82（出院后应对）、0.71（治疗依从性）和 0.66（参与出院计划）。DICARES 与北欧患者体验问卷呈中度相关（rho=0.49，P<0.001）。与 30 天内紧急再入院的患者相比，无再入院的患者的 DICARES 总分更高（P<0.001），这表明更多积极的体验与更少的再入院相关。
DICARES 似乎是一种可行的衡量老年患者（≥65 岁）出院护理质量的工具。该简明问卷似乎对再入院较为敏感，且与合并症无关。有必要进一步研究患者的体验，以确定对其他患者群体的出院护理有影响的因素。
