Levy David A, Jordan Harmon S, Lalor John P, Smirnova Jenni Kim, Hu Wen, Liu Weisong, Yu Hong
Department of Computer Science, University of Massachusetts Lowell, Lowell, MA.
Assistant Professor, Tufts University School of Medicine, Boston, MA.
Health Policy Technol. 2024 Dec;13(6). doi: 10.1016/j.hlpt.2024.100932. Epub 2024 Nov 3.
Patients have difficulty understanding medical jargon in electronic health record (EHR) notes. Lay definitions can improve patient comprehension, which is the goal of the NoteAid project. We assess whether the NoteAid definitions are understandable to laypeople and whether understandability differs with respect to layperson characteristics.
Definitions for jargon terms were written for laypersons with a 4th-to-7th-grade reading level. 300 definitions were randomly sampled from a corpus of approximately 30,000 definitions. 280 laypeople (crowdsource workers) were recruited; each layperson rated the understandability of 20 definitions. Understandability was rated on a 5-point scale. Using a generalized estimating equation model (GEE) we analyzed the relationship between understandability and age, sex, race/ethnicity, education level, native language, health literacy, and definition writer.
Overall, 81.1% (95% CI: 76.5-85.7%) of the laypeople reported that the definitions were understandable. Males were less likely to report understanding the definitions than females (OR: 0.73, 95% CI: 0.63-0.84). Asians, Hispanics, and those who marked their race/ethnicity as "other" were more likely to report understanding the definitions than whites (Asians: OR: 1.43, 95% CI: 1.17-1.73; Hispanics: OR: 1.86, 95% CI: 1.33-2.59; Other: OR: 2.48, 95% CI: 1.65-3.74). Laypeople whose native language was not English were less likely to report understanding the definitions (OR: 0.51, 95% CI: 0.36-0.74). Laypeople with lower health literacy were less likely to report understanding definitions (health literacy score 3: OR: 0.51, 95% CI: 0.43-0.62; health literacy score 4: OR: 0.40, 95% CI: 0.29-0.55).
Understandability of definitions among laypeople was high. There were statistically significant race/ethnic differences in self-reported understandability, even after controlling for multiple demographics.
患者在理解电子健康记录（EHR）笔记中的医学术语方面存在困难。通俗易懂的定义可以提高患者的理解能力，这是NoteAid项目的目标。我们评估NoteAid定义外行人是否能够理解，以及理解程度是否因外行人的特征而异。
为四至七年级阅读水平的外行人编写术语的定义。从大约30000个定义的语料库中随机抽取300个定义。招募了280名外行人（众包工作者）；每位外行人对20个定义的可理解性进行评分。可理解性采用5分制进行评分。我们使用广义估计方程模型（GEE）分析了可理解性与年龄、性别、种族/民族、教育水平、母语、健康素养和定义编写者之间的关系。
总体而言，81.1%（95%CI：76.5-85.7%）的外行人表示这些定义是可以理解的。男性比女性更不太可能表示理解这些定义（OR：0.73，95%CI：0.63-0.84）。亚洲人、西班牙裔以及那些将自己的种族/民族标记为“其他”的人比白人更有可能表示理解这些定义（亚洲人：OR：1.43，95%CI：1.17-1.73；西班牙裔：OR：1.86，95%CI：1.33-2.59；其他：OR：2.48，95%CI：1.65-3.74）。母语不是英语的外行人更不太可能表示理解这些定义（OR：0.51，95%CI：0.36-0.74）。健康素养较低的外行人更不太可能表示理解定义（健康素养得分3：OR：0.51，95%CI：0.43-0.62；健康素养得分4：OR：0.40，95%CI：0.29-0.55）。
外行人对定义的理解程度较高。即使在控制了多种人口统计学因素之后，自我报告的可理解性在种族/民族方面仍存在统计学上的显著差异。
