Psychometric evaluation of the Readiness for Discharge Questionnaire

Objective: The Readiness for Discharge Questionnaire (RDQ) was developed as an easy to use tool for assessing readiness for discharge, independent of socio-economic factors, for inpatients with schizophrenia. The psychometric properties of the RDQ are described. Methods: The RDQ consists of 6 items assessing suicidality/homicidality, control of aggression/impulsivity, activities of daily living, medication-taking, delusions/hallucinations interfering with functioning and global status. A final yes/no question assesses readiness for discharge. Data derived from 3 studies (500 patients in 3 countries) were used in analyzing inter-rater and test-retest reliability, content and construct validity, and sensitivity to change. Results: The inter-rater reliability was high for all items of the RDQ (reliability coefficients > 0.9) and moderate to high for the readiness for discharge status (Session I: 84% agreement, kappa 0.39, polychoric correlation r = 0.81; Session II: 89% agreement, kappa 0.63, polychoric correlation r = 0.81. Test-retest reliability was also high for all items of the RDQ (reliability coefficients > 0.9) and the readiness for discharge status (kappa = 0.743; tetrachoric correlation r = 0.819). Overall, 84% of the raters agreed (mean score = 5.0 of possible 6.0) that the RDQ was useful in assessing a patient's readiness for discharge from the hospital. Evidence of good construct validity included significant correlations with PANSS total and factor scores, and a significant relationship with actual discharge. Significantly more patients with symptom improvement were judged ready for discharge (compared to those without symptom improvement), indicating that the RDQ was sensitive to change over time. Conclusions: The RDQ has favorable reliability and validity properties, and is an easy to use instrument in research studies for assessing readiness for discharge of inpatients with schizophrenia. Additional work in naturalistic settings is required to further validate the instrument for routine clinical use. (c) 2005 Elsevier B.V. All rights reserved.