8 Australian Journal of Advanced Nursing 2001 Volume 18 Number 4 ABSTRACT The aim of this study was to develop and investigate the validity and reliability of the Hospital-in-the-Home (HITH) Dependency Scale (HDS). The HDS is a new instrument designed to measure the dependency of HITH patients. It calculates an overall dependency level by rating four dimensions of the provision of HITH nursing care. Specifically, these dimensions are the complexity of assessment, complexity of treatment, time taken to provide the treatment, and the frequency of treatment. The results of testing the HDS suggest that it is valid in measuring adult medical and surgical HITH patient dependency. The scale demonstrated strong stability over time in test retest procedures over a one month period (r = 0.80, p <0.01) and internal consistency (Cronbach’s alpha = 0.72). We conclude that the HDS is a valid, reliable instrument that is quick and easy to use in the HITH setting. INTRODUCTION F or many years the measurement of patient acuity and dependency has been undertaken in the hospital setting utilising a variety of instruments. The needs for such measurements stem from various clinical and administrative sources including; the prediction of the chances of survival of a critically ill patient; the determination of nurse staffing requirements; resource allocation and the assessment of appropriateness of care. More recently the advent of new treatment options, such as hospital in the home (HITH) programs, has highlighted the need for new instruments to objectively capture the acuity and dependency of patients treated in such programs. When existing measures, such as the Appropriateness Evaluation Protocol (Gertman and Restuccia 1981) are applied to HITH patients, they have been found to lack the necessary sensitivity required to accurately capture the characteristics of these patients and unique elements of their care in the home setting. Nick Santamaria, RN, RPN, BAppSc(Adv Nsg), GradDipHealthEd, MEdSt, PhD, MRCNA, is Principal Research Scientist - The Alfred Hospital, Melbourne; and Associate Professor, School of Postgraduate Nursing, University of Melbourne Sue Daly, RN, DipAppSc(Nursing), BN, MN, FRCNA, is Business Manager - Victorian Centre for Ambulatory Care Innovation, Melbourne, Australia Rachael Addicott, BA(Hons), is Research Assistant - Victorian Centre for Ambulatory Care Innovation, Melbourne, Australia Lexie Clayton, RN, RM, BN, MHA, FRCNA, AFACHSA, is Director of Ambulatory and Community Services, The Alfred Hospital, Melbourne; and Associate Professor, School of Postgraduate Nursing, University of Melbourne Accepted for publication July 2000 ACKNOWLEDGEMENT: The authors gratefully acknowledge the contributions made to this project by the following individuals: Helen Hamilton, Box Hill Hospital Robyn Kirsch, Maroondah Hospital Mara Langley, Mercy Hospital for Women Joanne Moss, Royal Melbourne Hospital Dianne Richards, The Alfred Hospital Tamara Rowan, St Vincent’s Hospital Melbourne Carole Staley, Victorian Centre for Ambulatory Care Innovation Gail Traa, Bairnsdale Regional Health Service Cathy Watty, Peter MacCallum Cancer Institute Marie Young, West Gippsland Healthcare Group THE DEVELOPMENT, VALIDITY AND RELIABILITY OF THE HOSPITAL IN THE HOME DEPENDENCY SCALE (HDS) RESEARCH PAPER Key words: stress, cognitive processes, personality, Lifestyle, difficult patients