Unaka Ndidi I, Statile Angela, Haney Julianne, Beck Andrew F, Brady Patrick W, Jerardi Karen E
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Hosp Med. 2017 Feb;12(2):98-101. doi: 10.12788/jhm.2688.
The average American adult reads at an 8th-grade level. Discharge instructions written above this level might increase the risk of adverse outcomes for children as they transition from hospital to home. We conducted a cross-sectional study at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. Two hundred charts for patients discharged from the hospital medicine service were randomly selected for review. Written discharge instructions were extracted and scored for readability (Fry Readability Scale [FRS]), understandability (Patient Education Materials Assessment Tool [PEMAT]), and completeness (5 criteria determined by consensus). Descriptive statistics enumerated the distribution of readability, understandability, and completeness of written discharge instructions. Of the patients included in the study, 51% were publicly insured. Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, 8-12; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability. The diagnosis was described in only 33% of the instructions. Although explicit warning signs were listed in most instructions, 38% of the instructions did not include information on the person to contact if warning signs developed. Overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home. Journal of Hospital Medicine 2017;12:98-101.
美国成年人的平均阅读水平为八年级。高于此水平编写的出院指导可能会增加儿童从医院过渡到家庭时出现不良后果的风险。我们在一家大型城市学术儿童医院进行了一项横断面研究，以描述出院时提供给家庭的书面指导的可读性水平、可理解性得分和完整性。随机抽取了200份医院内科服务出院患者的病历进行审查。提取书面出院指导并对其进行可读性（弗莱可读性量表[FRS]）、可理解性（患者教育材料评估工具[PEMAT]）和完整性（由共识确定的5项标准）评分。描述性统计列举了书面出院指导的可读性、可理解性和完整性的分布情况。在纳入研究的患者中，51%为公共保险患者。中位年龄为3.1岁，中位住院时间为2.0天。中位可读性得分相当于十年级阅读水平（四分位间距，8 - 12；范围，1 - 13）。PEMAT中位得分为73%（四分位间距，64% - 82%；范围，45% - 100%）；36%的指导得分低于70%，与理解性欠佳相关。仅33%的指导中描述了诊断情况。尽管大多数指导中列出了明确的警示标志，但38%的指导未包括出现警示标志时应联系的人员信息。总体而言，出院指导的可读性、可理解性和完整性均未达标准。努力改进出院指导的内容可能会促进安全有效的回家过渡。《医院医学杂志》2017年；12：98 - 101。
