{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T20:52:39Z","timestamp":1762375959294},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objective Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge.<\/jats:p>\n               <jats:p>Materials and Methods We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based \u201cdischarge module,\u201d which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0\u2013100 scale, with higher scores indicating greater readability) and the Flesch\u2013Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis).<\/jats:p>\n               <jats:p>Results Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P &amp;lt; .001) and lower FKGL scores (5.6 vs. 7.6, P &amp;lt; .001), compared to clinician-generated discharge instructions.<\/jats:p>\n               <jats:p>Discussion The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient\u2019s specific discharge diagnosis.<\/jats:p>\n               <jats:p>Conclusions Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.<\/jats:p>","DOI":"10.1093\/jamia\/ocv005","type":"journal-article","created":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T00:41:42Z","timestamp":1429231302000},"page":"857-863","source":"Crossref","is-referenced-by-count":21,"title":["Readability of patient discharge instructions with and without the use of electronically available disease-specific templates"],"prefix":"10.1093","volume":"22","author":[{"given":"Stephanie K","family":"Mueller","sequence":"first","affiliation":[{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}]},{"given":"Kyla","family":"Giannelli","sequence":"additional","affiliation":[{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}]},{"given":"Robert","family":"Boxer","sequence":"additional","affiliation":[{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}]},{"given":"Jeffrey L","family":"Schnipper","sequence":"additional","affiliation":[{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}]}],"member":"286","published-online":{"date-parts":[[2015,4,16]]},"reference":[{"key":"2020110613025852100_ocv005-B1","article-title":"Adult literacy in America: a first look at the findings of the National Adult Literacy Survey","author":"Kirsch","year":"2002"},{"key":"2020110613025852100_ocv005-B2","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1001\/jama.1995.03530210073035","article-title":"Patients who can't read. Implications for the health care system","volume":"274","author":"Miles","year":"1995","journal-title":"JAMA."},{"issue":"4","key":"2020110613025852100_ocv005-B3","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1086\/367857","article-title":"Knowledge of antiretroviral regimen dosing and adherence: a longitudinal study","volume":"36","author":"Miller","year":"2003","journal-title":"Clin Infect Dis."},{"issue":"5","key":"2020110613025852100_ocv005-B4","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1046\/j.1525-1497.1999.00334.x","article-title":"Adherence to combination antiretroviral therapies in HIV patients of low health literacy","volume":"14","author":"Kalichman","year":"1999","journal-title":"J Gen Intern Med."},{"issue":"12","key":"2020110613025852100_ocv005-B5","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1046\/j.1525-1497.1998.00242.x","article-title":"Health literacy and the risk of hospital admission","volume":"13","author":"Baker","year":"1998","journal-title":"J Gen Intern Med."},{"issue":"8","key":"2020110613025852100_ocv005-B6","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.2105\/AJPH.92.8.1278","article-title":"Functional health literacy and the risk of hospital admission among Medicare managed care enrollees","volume":"92","author":"Baker","year":"2002","journal-title":"Am J Public Health."},{"issue":"3","key":"2020110613025852100_ocv005-B7","first-page":"463","article-title":"Health literacy: the gap between physicians and patients","volume":"72","author":"Safeer","year":"2005","journal-title":"Am Fam Physician."},{"issue":"14","key":"2020110613025852100_ocv005-B8","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1001\/archinte.167.14.1503","article-title":"Health literacy and mortality among elderly persons","volume":"167","author":"Baker","year":"2007","journal-title":"Arch Intern Med."},{"issue":"8","key":"2020110613025852100_ocv005-B9","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/j.1525-1497.2006.00539.x","article-title":"Limited literacy and mortality in the elderly: the health, aging, and body composition study","volume":"21","author":"Sudore","year":"2006","journal-title":"J Gen Intern Med."},{"key":"2020110613025852100_ocv005-B10"},{"key":"2020110613025852100_ocv005-B11","volume-title":"Agency for Healthcare Research and Quality (AHRQ)","author":"Health Literacy Universal Precautions Toolkit","year":"2010"},{"key":"2020110613025852100_ocv005-B12"},{"key":"2020110613025852100_ocv005-B13"},{"key":"2020110613025852100_ocv005-B14","doi-asserted-by":"crossref","first-page":"E1035","DOI":"10.1111\/j.1553-2712.2012.01425.x","article-title":"Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest?","volume":"19","author":"Engel","year":"2012","journal-title":"Acad Emerg Med."},{"key":"2020110613025852100_ocv005-B15","first-page":"NV2014","article-title":"Impact of a web-based discharge module on timeliness and quality of discharge documentation. Society of Hospital Medicine Annual Meeting","author":"Nolido","journal-title":"Las Vegas."},{"key":"2020110613025852100_ocv005-B16"},{"issue":"3","key":"2020110613025852100_ocv005-B17","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/1090198105277329","article-title":"A systematic review of readability and comprehension instruments used for print and web-based cancer information","volume":"33","author":"Friedman","year":"2006","journal-title":"Health Educ Behav."},{"issue":"3","key":"2020110613025852100_ocv005-B18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1037\/h0057532","article-title":"A new readability yardstick","volume":"32","author":"Flesch","year":"1948","journal-title":"J Appl Psychol."},{"key":"2020110613025852100_ocv005-B19","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0738-3991(91)90017-Y","article-title":"Readability formulas: cautions and criterias","volume":"17","author":"Meade","year":"1991","journal-title":"Patient Educ Couns."},{"issue":"2","key":"2020110613025852100_ocv005-B20","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/j.1525-1497.2005.40208.x","article-title":"Interventions to improve health outcomes for patients with low literacy. A systematic review","volume":"20","author":"Pignone","year":"2005","journal-title":"J Gen Intern Med."},{"issue":"1","key":"2020110613025852100_ocv005-B21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0738-3991(97)00053-0","article-title":"A polio immunization pamphlet with increased appeal and simplified language does not improve comprehension to an acceptable level","volume":"33","author":"Davis","year":"1998","journal-title":"Patient Educ Couns."},{"issue":"1","key":"2020110613025852100_ocv005-B22","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2105\/AJPH.84.1.119","article-title":"Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer","volume":"84","author":"Meade","year":"1994","journal-title":"Am J Public Health."},{"issue":"3","key":"2020110613025852100_ocv005-B23","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/00007611-200093030-00010","article-title":"Comparing the effectiveness of video and written material for improving knowledge among sleep disorders clinic patients with limited literacy skills","volume":"93","author":"Murphy","year":"2000","journal-title":"South Med J."},{"issue":"2","key":"2020110613025852100_ocv005-B24","first-page":"240","article-title":"Patient comprehension of written drug information","volume":"37","author":"Eaton","year":"1980","journal-title":"Am J Hosp Pharm."},{"key":"2020110613025852100_ocv005-B25","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1080\/10810730.2012.715233","article-title":"Health literacy and 30-day postdischarge hospital utilization","volume":"17","author":"Mitchell","year":"2012","journal-title":"J Health Commun."},{"issue":"3","key":"2020110613025852100_ocv005-B26","doi-asserted-by":"crossref","first-page":"178","DOI":"10.7326\/0003-4819-150-3-200902030-00007","article-title":"A reengineered hospital discharge program to decrease rehospitalization: a randomized trial","volume":"150","author":"Jack","year":"2009","journal-title":"Ann Intern Med."},{"issue":"3","key":"2020110613025852100_ocv005-B27","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.pec.2007.01.020","article-title":"Development of an illustrated medication schedule as a low-literacy patient education tool","volume":"66","author":"Kripalani","year":"2007","journal-title":"Patient Educ Couns."},{"issue":"2","key":"2020110613025852100_ocv005-B28","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1177\/1359105312440300","article-title":"Illustrated medication instructions as a strategy to improve medication management among Latinos: a qualitative analysis","volume":"18","author":"Mohan","year":"2013","journal-title":"J Health Psychol."},{"issue":"6","key":"2020110613025852100_ocv005-B29","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3928\/00989134-20120509-01","article-title":"Improving medication management among at-risk older adults","volume":"38","author":"Martin","year":"2012","journal-title":"J Gerontol Nurs."},{"issue":"4","key":"2020110613025852100_ocv005-B30","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/00006199-199807000-00006","article-title":"Randomized trial of geragogy-based medication instruction in the emergency department","volume":"47","author":"Hayes","year":"1998","journal-title":"Nurs Res."},{"issue":"10","key":"2020110613025852100_ocv005-B31","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/BF02640361","article-title":"The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills","volume":"10","author":"Parker","year":"1995","journal-title":"J Gen Intern Med."},{"issue":"1","key":"2020110613025852100_ocv005-B32","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0738-3991(98)00116-5","article-title":"Development of a brief test to measure functional health literacy","volume":"38","author":"Baker","year":"1999","journal-title":"Patient Educ Couns."}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/4\/857\/34145563\/ocv005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/4\/857\/34145563\/ocv005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T18:56:42Z","timestamp":1604689002000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/22\/4\/857\/1746200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4,16]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2015,4,16]]},"published-print":{"date-parts":[[2015,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocv005","relation":{},"ISSN":["1527-974X","1067-5027"],"issn-type":[{"value":"1527-974X","type":"electronic"},{"value":"1067-5027","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,7]]},"published":{"date-parts":[[2015,4,16]]}}}