Occup. Ther. Int. 15(4): 285–287 (2008)Copyright © 2008 John Wiley & Sons, Ltd DOI: 10.1002/oti

Letter to the Editor

Regarding ‘Hospital discharge among frail elderly people: a pilot study in Sweden’ by I. Soderback

I would like to comment on how encouraged I was by Ingrid Soderback’s (2008) article, ‘Hospital discharge among frail elderly people: a pilot study in Sweden’. With health services globally demanding an increased emphasis on demonstrat-ing quality of care, it is vitally important to see paper such as these that scruti-nize the value of occupational therapy upon quality patient care. Unfortunately, such papers are limited in the current literature.

A pleasing aspect of this study was that it chose to use patients’ perception of quality of care in order to explore the viability of an occupational therapy clinical tool, namely, a conceptual framework for the hospital discharge process. Enabling effective discharge is often where occupational therapy core skills are most essential (and most utilized by the interdisciplinary team). Therefore, it was reassuring to note that the frail elderly population interviewed for this study reported services at discharge as being acceptable, satisfactory, trustworthy and timely.

Although this pilot study did not set out primarily to measure overall quality, the components of the discharge framework that were used (environmental, individual and outcome components) correlate well with often-used dimensions of quality of care – structure, process and outcome (Donabedian, 1988). This is important in terms of occupational therapy departments striving to provide a better quality service. Such conceptualization of quality as three dimensions (structure, process and outcome) helps to focus attention not only on how to judge good and bad services but also on how to develop their quality (Donaldson, 2008).

If occupational therapy departments were to focus their services according to patient satisfaction, the results from the Soderback study would encourage prioritization upon the most appreciated interventions – assessment of home environment, improving house accessibility and prescription of assistive devices.

In their review of theoretical and empirical work on patient satisfaction with care, Cleary and McNeil (1988) found that characteristics of providers or orga-

OCCUPATIONAL THERAPY INTERNATIONALOccup. Ther. Int. 15(4): 285–287 (2008)Published online 4 November 2008 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/oti.260

286 Murphy

Occup. Ther. Int. 15(4): 285–287 (2008)Copyright © 2008 John Wiley & Sons, Ltd DOI: 10.1002/oti

nizations that result in more ‘personal’ care are associated with higher levels of satisfaction. So perhaps it is not surprising that these interventions scored highest with patient satisfaction outcome measures during the discharge process. After all, there cannot be many more personal aspects of care than assisting people achieve their maximal functional capacity with their activities of daily living or being invited to access a patient’s home (in order to optimize safety and accessibility).

Although it is reported that increased personal care leads to increased sat-isfaction, a recent study by Moats (2007) challenges this thinking by illustrating that home visits can often leave patients (particularly the frail) feeling anxious, coerced or intimidated, not satisfi ed or what one would equate with increased satisfaction.

So while this pilot study has determined that the Discharged Patients’ Enquiry Questionnaire (DPEQ) could be a viable tool for future evaluation of occupational therapy services (particularly with frail elderly people and during the discharge process), I believe it may be insuffi cient to rely solely upon an outcome measure that focuses on patient perception of quality of care.

While Soderback’s recommendations for methodological improvements are noted, I would also encourage results of the DPEQ to be analysed alongside prospective observational studies of occupational therapy interventions within the discharge process, or alongside review of recommendations made in occu-pational therapy pre- and post-discharge home visit reports. I feel that such analysis would further provide valuable information on the quality of occupa-tional therapy interventions provided during the discharge process.

In closing, I would like to commend the author on this pilot study and its contribution towards increasing the accountability of our profession, in this case, by attempting to quantify the components of a process that occupational therapists would generally consider themselves to be integral to – the discharge process.

As Soderback (2008, 28) has asserted, ‘the hospital discharge process con-ceptual framework provides occupational therapists with a method to holisti-cally examine each component of the discharge process and the outcomes, as measured by use of the DPEQ’. Considering that striving for a holistic approach within individual client interactions is the essence of our clinical work, it should follow that we apply similar scrutiny to our overall service in order to improve the quality of care we provide. Brett Murphy Yarraville, Victoria, Australia

References

Cleary PD, McNeil BJ (1988). Patient satisfaction as an indicator of quality care. Inquiry 25: 25–36.

Donabedian A (1988). The quality of care: how can it be assessed? The Journal of the American Medical Association 260: 1743–1748.

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Occup. Ther. Int. 15(4): 285–287 (2008)Copyright © 2008 John Wiley & Sons, Ltd DOI: 10.1002/oti

Donaldson, L (2008). The challenge of quality and patient safety. Journal of the Royal Society of Medicine 101: 338–341.

Moats G (2007). Discharge decision-making, enabling occupations, and client-centred practice. The Canadian Journal of Occupational Therapy 74: 91–101. (Available at: ProQuest Infor-mation and Learning, Ann Arbor, Mi.) (Accessed 30 August 2008). http://proquest.umi.com.ezproxy.lib.monash.edu/pqdweb?did=125903291&sid=1&Fmt=3@clientld=16397&RQT =309&vname=PQD.

Soderback I (2008). Hospital discharge among frail elderly people: a pilot study in Sweden. Occupational Therapy International 15: 18–31.