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Hospital Care for adult patients with IDD: Improving the patient experience

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* 1. Does your hospital have specific IDD Care practice standards?

Yes

No

Don't know

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* 2. How well does the hospital staff understand the following:

	Poor	Fair	Neutral	Good	Excellent
a. The client's level of functioning	a. The client's level of functioning Poor	a. The client's level of functioning Fair	a. The client's level of functioning Neutral	a. The client's level of functioning Good	a. The client's level of functioning Excellent
b. The client's communication patterns	b. The client's communication patterns Poor	b. The client's communication patterns Fair	b. The client's communication patterns Neutral	b. The client's communication patterns Good	b. The client's communication patterns Excellent
c. What is frightening to the client	c. What is frightening to the client Poor	c. What is frightening to the client Fair	c. What is frightening to the client Neutral	c. What is frightening to the client Good	c. What is frightening to the client Excellent
d. What is calming to the client	d. What is calming to the client Poor	d. What is calming to the client Fair	d. What is calming to the client Neutral	d. What is calming to the client Good	d. What is calming to the client Excellent
e. Environmental stimuli may be disruptive to the client	e. Environmental stimuli may be disruptive to the client Poor	e. Environmental stimuli may be disruptive to the client Fair	e. Environmental stimuli may be disruptive to the client Neutral	e. Environmental stimuli may be disruptive to the client Good	e. Environmental stimuli may be disruptive to the client Excellent
f. The client should be respected and spoken to	f. The client should be respected and spoken to Poor	f. The client should be respected and spoken to Fair	f. The client should be respected and spoken to Neutral	f. The client should be respected and spoken to Good	f. The client should be respected and spoken to Excellent

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* 3. How satisfied are you with these aspects of hospital care?

	Poor	Fair	Neutral	Good	Excellent
a. Communication between DSP's and hospital staff	a. Communication between DSP's and hospital staff Poor	a. Communication between DSP's and hospital staff Fair	a. Communication between DSP's and hospital staff Neutral	a. Communication between DSP's and hospital staff Good	a. Communication between DSP's and hospital staff Excellent
b. Appreciate the client's current living situation	b. Appreciate the client's current living situation Poor	b. Appreciate the client's current living situation Fair	b. Appreciate the client's current living situation Neutral	b. Appreciate the client's current living situation Good	b. Appreciate the client's current living situation Excellent
c. Understand the client's prior health treatments and care before the hospital	c. Understand the client's prior health treatments and care before the hospital Poor	c. Understand the client's prior health treatments and care before the hospital Fair	c. Understand the client's prior health treatments and care before the hospital Neutral	c. Understand the client's prior health treatments and care before the hospital Good	c. Understand the client's prior health treatments and care before the hospital Excellent
d. The level of communication that the hospital has with the clients outpatient care providers	d. The level of communication that the hospital has with the clients outpatient care providers Poor	d. The level of communication that the hospital has with the clients outpatient care providers Fair	d. The level of communication that the hospital has with the clients outpatient care providers Neutral	d. The level of communication that the hospital has with the clients outpatient care providers Good	d. The level of communication that the hospital has with the clients outpatient care providers Excellent
e. Clarity of discharge instructions back to home	e. Clarity of discharge instructions back to home Poor	e. Clarity of discharge instructions back to home Fair	e. Clarity of discharge instructions back to home Neutral	e. Clarity of discharge instructions back to home Good	e. Clarity of discharge instructions back to home Excellent
f. Understand the local/state IDD support system	f. Understand the local/state IDD support system Poor	f. Understand the local/state IDD support system Fair	f. Understand the local/state IDD support system Neutral	f. Understand the local/state IDD support system Good	f. Understand the local/state IDD support system Excellent

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* 4. What has been your experience with these various issues in the hospital??

	Poor	Fair	Neutral	Good	Excellent
a. Allowance for DSP's/family to stay with client	a. Allowance for DSP's/family to stay with client Poor	a. Allowance for DSP's/family to stay with client Fair	a. Allowance for DSP's/family to stay with client Neutral	a. Allowance for DSP's/family to stay with client Good	a. Allowance for DSP's/family to stay with client Excellent
b. Use of mechanical and chemical restraints	b. Use of mechanical and chemical restraints Poor	b. Use of mechanical and chemical restraints Fair	b. Use of mechanical and chemical restraints Neutral	b. Use of mechanical and chemical restraints Good	b. Use of mechanical and chemical restraints Excellent
c. Skin breakdown	c. Skin breakdown Poor	c. Skin breakdown Fair	c. Skin breakdown Neutral	c. Skin breakdown Good	c. Skin breakdown Excellent
d. Unexpected falls	d. Unexpected falls Poor	d. Unexpected falls Fair	d. Unexpected falls Neutral	d. Unexpected falls Good	d. Unexpected falls Excellent
e. Aspiration	e. Aspiration Poor	e. Aspiration Fair	e. Aspiration Neutral	e. Aspiration Good	e. Aspiration Excellent
f. Pronged length of stay	f. Pronged length of stay Poor	f. Pronged length of stay Fair	f. Pronged length of stay Neutral	f. Pronged length of stay Good	f. Pronged length of stay Excellent
g. Readmission for the same problem within 30 days	g. Readmission for the same problem within 30 days Poor	g. Readmission for the same problem within 30 days Fair	g. Readmission for the same problem within 30 days Neutral	g. Readmission for the same problem within 30 days Good	g. Readmission for the same problem within 30 days Excellent

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* 5. Are these outpatient health services available?

	Yes	No	Don't know
a. Health promotion/Prevention	a. Health promotion/Prevention Yes	a. Health promotion/Prevention No	a. Health promotion/Prevention Don't know
b. Medication education	b. Medication education Yes	b. Medication education No	b. Medication education Don't know
c. Dental Hygiene	c. Dental Hygiene Yes	c. Dental Hygiene No	c. Dental Hygiene Don't know
d. Healthcare Coordinator	d. Healthcare Coordinator Yes	d. Healthcare Coordinator No	d. Healthcare Coordinator Don't know
e. Formalized Health documents for each health visit	e. Formalized Health documents for each health visit Yes	e. Formalized Health documents for each health visit No	e. Formalized Health documents for each health visit Don't know
f. List of local IDD Healthcare Providers	f. List of local IDD Healthcare Providers Yes	f. List of local IDD Healthcare Providers No	f. List of local IDD Healthcare Providers Don't know
g. Palliative and End of Life training	g. Palliative and End of Life training Yes	g. Palliative and End of Life training No	g. Palliative and End of Life training Don't know

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* 6. In your opinion, what is the overall level of health of the individuals you support?

a. Poor

b. Fair

c. Neutral

d. Good

f. Excellent