Language and Readability Barriers in Discharge Instructions: A Call to Improve Patient Aftercare - 17/07/25
Abstract |
Background |
Inadequate health literacy is linked to worse health outcomes, including higher readmission rates and adverse events. Despite recommendations to keep patient materials at or below a sixth-grade reading level, many discharge instructions exceed this threshold. This study examined the language availability of Epic's discharge documents and assessed their alignment with readability standards.
Methods |
In December 2024, Epic discharge documents on adult medical conditions were extracted in English and Spanish, along with their easy-to-read versions, when available. Readability was assessed using 2 scoring systems for each language. Comparisons with the recommended grade levels and between document versions were analyzed using right-sided and paired t-tests, respectively. Trends in grade levels by the month of revision were assessed using linear regressions.
Results |
Across 1511 discharge instructions, the standard documents were available in 15 languages. For standard English documents, 81% surpassed the American Medical Association's sixth-grade threshold on Flesch-Kincaid Grade Level (P < .05) and 100% on Simple Measure of Gobbledygook (P < .05). For standard Spanish documents, 0% were above the threshold on Fernández-Huerta (P = 1.00) and 100% on adjusted Simple Measure of Gobbledygook (P < .05). The easy-to-read versions had significantly lower grade levels than their standard counterparts (P < .05). Regression analyses revealed no significant changes in the grade level of discharge documents by revision month (P > .05).
Conclusions |
Epic's discharge instructions are infrequently offered in languages other than English and Spanish, and often exceed the recommended reading levels. Given the impact of readability on patient outcomes, discharge documents should be improved to enhance patient comprehension and adherence.
El texto completo de este artículo está disponible en PDF.Keywords : Discharge instructions, Health literacy, Patient comprehension, Readability
Esquema
| Funding: None. |
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| Conflict of Interest: None. The authors declare the following financial interests and personal relationships that may be considered as potential competing interests: BGD reports the following: receives consulting fees from Medtronic and Spineart, chief executive officer and shareholder at Spinal Alignment Solutions. AHD discloses the following: receives royalties from Spineart and Stryker; consulting fees from Medtronic; research support from Alphatec, Medtronic, and Orthofix; and fellowship support from Medtronic. All other authors declare no conflicts of interest. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. MS: Writing – original draft, Methodology, Conceptualization; MS: Writing – original draft; JEN: Writing – original draft; MJF: Writing – original draft; AHM: Writing – original draft; BGD: Writing – review & editing; AHD: Writing – review & editing, Supervision. |
Vol 138 - N° 8
P. 1159-1168 - août 2025 Regresar al número
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