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Quality Assessment of Physician Discharge Summaries: Instrument Development and Reliability Study
Leopold Bentheim1,2, Leonard Fehring1, Hendrik Friederichs3
1Department of Health Care Informatics, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, North Rhine-Westphalia, Germany.
Background:
Discharge summaries (DSs) are key clinical documents at the interface between inpatient and outpatient care. Their quality affects continuity of care, coordination, and patient safety, yet information transfer at discharge is often incomplete, delayed, or unclear. Standardized instruments for assessing DS quality remain scarce.
Objective:
This study aimed to develop a structured, recipient-oriented quality assessment instrument (QAI) for physician DS as a pragmatic measure of discharge communication quality and to conduct an initial evaluation of its applicability and interrater reliability.
Methods:
We conducted a formative instrument development study using a structured, iterative author panel consensus process informed by Delphi principles, condensing 43 recipient-oriented DS criteria into 12 items across 3 domains: medical content, structure and organization, and language and clarity. It was applied in a pragmatic pilot reliability evaluation to 20 anonymized internal medicine DSs, independently assessed by 5 physician raters with heterogeneous clinical backgrounds who were not involved in QAI development. Interrater reliability was evaluated using Krippendorff alpha and quadratically weighted Gwet agreement coefficient 2 (AC2). Reporting followed the Guidelines for Reporting Reliability and Agreement Studies.
Results:
The median overall quality score was 78.5% (IQR 75.3%-82.5%), and the mean was 79.1% (SD 5.0%). Scores were highest for language and clarity and lowest for medical content. Overall interrater reliability differed by coefficient: Krippendorff α was 0.45 (95% CI 0.34-0.55) whereas Gwet AC2 was 0.76 (95% CI 0.70-0.80). The largest discrepancy was observed for language and clarity, with an α of 0.02 (95% CI -0.06 to 0.10) and an AC2 of 0.88 (95% CI 0.84-0.91).
Conclusions:
The QAI provides preliminary evidence for a clinically applicable approach to assessing key quality dimensions of physician DS. Interrater reliability varied across domains and reliability coefficients, with a marked discrepancy between AC2 and Krippendorff alpha for language and clarity. These findings support its use for exploratory quality improvement and future validation.
