In the United States, 21‐23% of the adult population have low literacy, and an additional 27% have low health literacy (difficulty understanding written health education materials). Written materials are commonly used to communicate with patients at time of discharge, but can vary in ease of readability. We evaluated the association of the use of templated discharge instructions with readability scores of discharge instructions provided to patients at hospital discharge.
We performed a retrospective cohort study of patients discharged from an academic medical center. Data were obtained from electronic medical records. Patients were eligible for inclusion if discharged from any inpatient service to home between October, 2011 and September, 2012, following initiation of a web‐based “discharge module,” a quality improvement initiative to improve written communication at discharge, that included optional use of disease‐specific templated discharge instructions. We examined the frequency of use of the templated discharge instructions. We then evaluated readability using two common measures: Flesch‐Kincaid Grade Level (FKGL) and Flesch Reading Ease Level (FREL) in discharges that provided templated discharge instructions (with or without modification) vs. discharges that provided clinician‐derived discharge instructions (where templated instructions were available and not used or were unavailable for the specific discharge diagnosis).
Of the 233 randomly selected patient discharges, 105 (45.1%) provided templated discharge instructions and 128 (54.9%) provided clinician‐derived discharge instructions (Figure 1). The mean FKGL of templated discharge instructions was grade 5.6 vs. 7.6 for clinician‐derived discharge instructions (p < 0.001). The mean FREL of templated discharge instructions was 71 vs. 57.4 for clinician‐derived discharge instructions (p < 0.001). These findings did not change when we excluded discharges where templated instructions were unavailable. In subgroup analysis, FKGL of discharge instructions did not differ significantly when templated instructions were modified versus used without modification (5.8 vs. 5.5, p=0.15). FREL of modified templated discharge instructions was 69.1 vs. 72.9 for templated instructions without modification (p=0.02).
We found that we still lack many disease‐specific templated discharge instructions within our “discharge module,” but that compared to discharges that used templated instructions, those that did not had significantly lower readability scores (higher FKGL and lower FREL). Modification of templated instructions, which may lead to more customized messages, did not appreciably detract from readability. Our findings suggest that templated instructions are more literacy friendly than clinician‐derived discharge instructions.
To cite this abstract:Mueller S, Giannelli K, Boxer R, Schnipper J. Comparison of Readability of Patient Discharge Instructions with and Without Use of Disease‐Specific Templates. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 162. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/comparison-of-readability-of-patient-discharge-instructions-with-and-without-use-of-diseasespecific-templates/. Accessed May 23, 2019.