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Language and Readability Barriers in Discharge Instructions: A Call to Improve Patient Aftercare
Maxwell Sahhar1, Manjot Singh1, Joseph E Nassar1
1Warren Alpert Medical School, Brown University, Providence, RI.
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.
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