Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting

Asad J. Choudhry, Moustafa Younis, Mohamed D. Ray-Zack, Amy E. Glasgow, Nadeem N. Haddad, Elizabeth B Habermann, Donald H. Jenkins, Stephanie F. Heller, Henry J. Schiller, Martin D. Zielinski

Research output: Contribution to journalArticle

Abstract

Introduction: Hospital discharge instructions provide critical information necessary for patients to manage their own care; however, often they are written at a substantially higher readability level than recommended (ie, 6th-grade level) by the American Medical Association and the National Institutes of Health. We hypothesize that improving the reading level of discharge instructions will decrease the number of patient telephone calls and readmissions in the posthospital setting. Methods: We conducted a prospective observational study. Patient discharge instructions were edited and incorporated to enhance the readability level in August 2015. Return telephone call and readmissions of patients admitted before the intervention from August 1, 2014, to January 31, 2015, were compared with the prospective cohort studied from September 1, 2015, to September 30, 2016. Results: A total of 1,072 patients were included (preintervention: n = 493, postintervention: n = 579). Patient demographics, injury characteristics, and education level were similar among both groups. The median discharge instruction readability level in the postintervention group was significantly lower (10.0, 95% CI 10.0–10.2 vs 8.6, 95% CI 8.8–8.9; P < .0001). The proportion of patients calling after hospital discharge was significantly reduced after the intervention (21.9% vs 9.0%; P < .0001). Monthly hospital readmissions were decreased by 50% for every 100 patients discharged after the intervention (1.9% vs 0.9%; P = .002). The proportion of patients calling and readmissions for poor pain control significantly decreased after the intervention (7.1% vs 2.59%; P = .0005 and 2.8% vs 1.0%; P = .029, respectively). Conclusion: Enhanced readability of discharge instructions was associated with a decrease in the number of telephone calls and readmissions in the posthospital setting, enhancing health literacy and simultaneously reducing the burden on providers. Improved patient instructions written to an appropriate level may also allow for better pain control in the posthospital setting.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - Jan 1 2018

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Patient Readmission
Telephone
Health Literacy
Pain
Patient Discharge
National Institutes of Health (U.S.)
American Medical Association
Observational Studies
Reading
Demography
Prospective Studies
Education
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

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Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting. / Choudhry, Asad J.; Younis, Moustafa; Ray-Zack, Mohamed D.; Glasgow, Amy E.; Haddad, Nadeem N.; Habermann, Elizabeth B; Jenkins, Donald H.; Heller, Stephanie F.; Schiller, Henry J.; Zielinski, Martin D.

In: Surgery (United States), 01.01.2018.

Research output: Contribution to journalArticle

Choudhry, Asad J. ; Younis, Moustafa ; Ray-Zack, Mohamed D. ; Glasgow, Amy E. ; Haddad, Nadeem N. ; Habermann, Elizabeth B ; Jenkins, Donald H. ; Heller, Stephanie F. ; Schiller, Henry J. ; Zielinski, Martin D. / Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting. In: Surgery (United States). 2018.
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abstract = "Introduction: Hospital discharge instructions provide critical information necessary for patients to manage their own care; however, often they are written at a substantially higher readability level than recommended (ie, 6th-grade level) by the American Medical Association and the National Institutes of Health. We hypothesize that improving the reading level of discharge instructions will decrease the number of patient telephone calls and readmissions in the posthospital setting. Methods: We conducted a prospective observational study. Patient discharge instructions were edited and incorporated to enhance the readability level in August 2015. Return telephone call and readmissions of patients admitted before the intervention from August 1, 2014, to January 31, 2015, were compared with the prospective cohort studied from September 1, 2015, to September 30, 2016. Results: A total of 1,072 patients were included (preintervention: n = 493, postintervention: n = 579). Patient demographics, injury characteristics, and education level were similar among both groups. The median discharge instruction readability level in the postintervention group was significantly lower (10.0, 95{\%} CI 10.0–10.2 vs 8.6, 95{\%} CI 8.8–8.9; P < .0001). The proportion of patients calling after hospital discharge was significantly reduced after the intervention (21.9{\%} vs 9.0{\%}; P < .0001). Monthly hospital readmissions were decreased by 50{\%} for every 100 patients discharged after the intervention (1.9{\%} vs 0.9{\%}; P = .002). The proportion of patients calling and readmissions for poor pain control significantly decreased after the intervention (7.1{\%} vs 2.59{\%}; P = .0005 and 2.8{\%} vs 1.0{\%}; P = .029, respectively). Conclusion: Enhanced readability of discharge instructions was associated with a decrease in the number of telephone calls and readmissions in the posthospital setting, enhancing health literacy and simultaneously reducing the burden on providers. Improved patient instructions written to an appropriate level may also allow for better pain control in the posthospital setting.",
author = "Choudhry, {Asad J.} and Moustafa Younis and Ray-Zack, {Mohamed D.} and Glasgow, {Amy E.} and Haddad, {Nadeem N.} and Habermann, {Elizabeth B} and Jenkins, {Donald H.} and Heller, {Stephanie F.} and Schiller, {Henry J.} and Zielinski, {Martin D.}",
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AU - Choudhry, Asad J.

AU - Younis, Moustafa

AU - Ray-Zack, Mohamed D.

AU - Glasgow, Amy E.

AU - Haddad, Nadeem N.

AU - Habermann, Elizabeth B

AU - Jenkins, Donald H.

AU - Heller, Stephanie F.

AU - Schiller, Henry J.

AU - Zielinski, Martin D.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: Hospital discharge instructions provide critical information necessary for patients to manage their own care; however, often they are written at a substantially higher readability level than recommended (ie, 6th-grade level) by the American Medical Association and the National Institutes of Health. We hypothesize that improving the reading level of discharge instructions will decrease the number of patient telephone calls and readmissions in the posthospital setting. Methods: We conducted a prospective observational study. Patient discharge instructions were edited and incorporated to enhance the readability level in August 2015. Return telephone call and readmissions of patients admitted before the intervention from August 1, 2014, to January 31, 2015, were compared with the prospective cohort studied from September 1, 2015, to September 30, 2016. Results: A total of 1,072 patients were included (preintervention: n = 493, postintervention: n = 579). Patient demographics, injury characteristics, and education level were similar among both groups. The median discharge instruction readability level in the postintervention group was significantly lower (10.0, 95% CI 10.0–10.2 vs 8.6, 95% CI 8.8–8.9; P < .0001). The proportion of patients calling after hospital discharge was significantly reduced after the intervention (21.9% vs 9.0%; P < .0001). Monthly hospital readmissions were decreased by 50% for every 100 patients discharged after the intervention (1.9% vs 0.9%; P = .002). The proportion of patients calling and readmissions for poor pain control significantly decreased after the intervention (7.1% vs 2.59%; P = .0005 and 2.8% vs 1.0%; P = .029, respectively). Conclusion: Enhanced readability of discharge instructions was associated with a decrease in the number of telephone calls and readmissions in the posthospital setting, enhancing health literacy and simultaneously reducing the burden on providers. Improved patient instructions written to an appropriate level may also allow for better pain control in the posthospital setting.

AB - Introduction: Hospital discharge instructions provide critical information necessary for patients to manage their own care; however, often they are written at a substantially higher readability level than recommended (ie, 6th-grade level) by the American Medical Association and the National Institutes of Health. We hypothesize that improving the reading level of discharge instructions will decrease the number of patient telephone calls and readmissions in the posthospital setting. Methods: We conducted a prospective observational study. Patient discharge instructions were edited and incorporated to enhance the readability level in August 2015. Return telephone call and readmissions of patients admitted before the intervention from August 1, 2014, to January 31, 2015, were compared with the prospective cohort studied from September 1, 2015, to September 30, 2016. Results: A total of 1,072 patients were included (preintervention: n = 493, postintervention: n = 579). Patient demographics, injury characteristics, and education level were similar among both groups. The median discharge instruction readability level in the postintervention group was significantly lower (10.0, 95% CI 10.0–10.2 vs 8.6, 95% CI 8.8–8.9; P < .0001). The proportion of patients calling after hospital discharge was significantly reduced after the intervention (21.9% vs 9.0%; P < .0001). Monthly hospital readmissions were decreased by 50% for every 100 patients discharged after the intervention (1.9% vs 0.9%; P = .002). The proportion of patients calling and readmissions for poor pain control significantly decreased after the intervention (7.1% vs 2.59%; P = .0005 and 2.8% vs 1.0%; P = .029, respectively). Conclusion: Enhanced readability of discharge instructions was associated with a decrease in the number of telephone calls and readmissions in the posthospital setting, enhancing health literacy and simultaneously reducing the burden on providers. Improved patient instructions written to an appropriate level may also allow for better pain control in the posthospital setting.

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