(Reuters Health)—Many patients leaving the hospital don’t understand follow-up care plans because the instructions are tailored to people with higher reading levels and more education, a recent U.S. study suggests.
The American Medical Association already recommends that written health information be targeted to a sixth grade audience because nearly half of the U.S. population is only marginally or functionally literate, with an elementary- or middle-school reading level, the researchers note in their report in the American Journal of Surgery, online Dec. 27.
But the current study of discharge instructions given to about 500 trauma patients leaving the hospital found that only one fourth had the reading skills necessary to adequately understand their dismissal notes.
Part of the problem is that these notes are written for two very different audiences—patients and families who need simple instructions and their doctors, who are accustomed to medical jargon, says senior study author Dr. Martin Zielinski, a trauma surgeon at the Mayo Clinic in Rochester, Minnesota.
“Even if patients believe they understand what occurred during their hospitalization and the instructions they are to follow upon dismissal, they can become confused after they leave the hospital environment as their memory can be clouded by medications they were administered, the stress of hospitalization, and, particularly within our patient population, traumatic brain injuries such as concussions,” Zielinski said by email.
To assess how easily the trauma patients in the study might decipher their discharge notes, Zielinski and colleagues used two standard formulas for determining reading levels based on the total words, syllables and sentences in texts.
Most of the 314 patients in the study who had education data available had a high school degree, while 22% had at least some college education. About 4% of these patients were functionally illiterate, with reading levels at fifth grade or below, and another 40% were marginally literate with a sixth- to eighth-grade reading level.
On average, the notes required at least a high school education to understand, the analysis found. By one measure the instructions were typically written at about a 10th grade reading level, while the other assessment found the notes might be easily understood by 13 to 15 year old students.
The difficulty of deciphering these notes didn’t appear to be different based on whether patients had surgery or how long they stayed in the hospital.
Patient reading level didn’t appear to influence the odds of returning to the hospital within a month of discharge or the likelihood that they would call the hospital with questions, the study found. But often, when these things happened, the patient had a reading level too low to understand the discharge notes.