Measuring the participation of elderly patients in the discharge process from hospital: a critical review of existing instruments

Measuring patients' experiences has been a major task for health care organisations during the past decade. The discharge process is identified as a vulnerable component of health care in need of assessment, especially when it concerns elderly persons. There are no published reviews or systematic assessment of the existing instruments developed to capture patients' perspective on the discharge process. This study gives a review of existing survey instruments designed to assess patients' perspectives on the discharge process. We used systematic searches for potentially relevant instruments in MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews for English language studies published between 1998 and 2009 was considered to evaluate the patients' perspective on the discharge process. Ten studies were included and assessed according to the established criteria, and the studies presented a total of 47 items related to participation. The review identified only one instrument designed specifically to capture participation in the discharge process. The main focus is on the information flow from the professional to the patient and never vice versa. Few of the instruments studied/analysed to what degree the patients were invited to share their knowledge, and none of the instruments inquired whether, in the patients' experiences, their perspective was taken into account. The major finding of the review is that none of the existing instruments capture the full range of participation, nor do they cover those areas of the discharge process identified by elderly patients themselves as the most essential.