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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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FACILITATING PATIENT
UNDERSTANDING OF
DISCHARGE INSTRUCTIONS

WORKSHOP SUMMARY

Joe Alper and Lyla M. Hernandez, Rapporteurs

Roundtable on Health Literacy

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
                OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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THE NATIONAL ACADEMIES PRESS    500 Fifth Street, NW    Washington, DC 20001

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This activity was supported by contracts between the National Academy of Sciences and the Agency for Healthcare Research and Quality (HHSP233200900537P); California Dental Association; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Resources and Services Administration (HHSH25034004T); Humana; Johnson & Johnson; Merck and Co., Inc.; Office of Disease Prevention and Health Promotion; and UnitedHealth Group. The views presented in this publication are those of the rapporteur and do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

International Standard Book Number-13: 978-0-309-30738-3
International Standard Book Number-10: 0-309-30738-4

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2014 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2014. Facilitating patient understanding of discharge instructions: Workshop summary. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

image

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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PLANNING COMMITTEE ON IMPLICATIONS OF HEALTH LITERACY FOR DISCHARGE INSTRUCTIONS1

DARREN DEWALT, Associate Professor of Medicine, University of North Carolina at Chapel Hill

BENARD DREYER, Professor of Pediatrics, New York University School of Medicine

ALEX FEDERMAN, Associate Professor of Medicine, Mount Sinai Hospital

GEORGE ISHAM, Senior Advisor, HealthPartners, Senior Fellow, HealthPartners Institute for Education and Research

RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine

_______________

1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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ROUNDTABLE ON HEALTH LITERACY1

GEORGE ISHAM (Chair), Senior Advisor, HealthPartners, Senior Fellow, HealthPartners Institute for Education and Research

WILMA ALVARADO-LITTLE, Director, Community Engagement/Outreach, University at Albany

CINDY BRACH, Senior Health Policy Researcher, Agency for Healthcare Research and Quality

GEM DAUS, Public Health Analyst, Health Resources and Services Administration

BENARD DREYER, Professor of Pediatrics, New York University School of Medicine

LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association

JILL GRIFFITHS, Vice President, Communications, Aetna

LORI HALL, Consultant, Health Education, Eli Lilly and Company

LINDA HARRIS, Team Leader, Health Communication and eHealth Team, U.S. Department of Health and Human Services

BETSY HUMPHREYS, Deputy Director, National Library of Medicine

MARGARET LOVELAND, Senior Director, Global Medical Affairs, Merck & Co., Inc.

PATRICK MCGARRY, Vice President, New Business Inovation and Connected Health, American Academy of Family Physicians

RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine

TERRI ANN PARNELL, Vice President, Health Literacy and Patient Education, North Shore–Long Island Jewish Health System

KIM PARSON, Consumer Experience Center of Excellence, Humana

KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, Brookings Institute

SUSAN PISANO, Vice President of Communications, America’s Health Insurance Plans

ANDREW PLEASANT, Senior Director for Health Literacy and Research, Canyon Ranch Institute

LINDSEY ROBINSON, President, California Dental Association

BERNARD ROSOF, Co-Chairman, National Priorities Partnership, National Quality Forum

RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard University School of Public Health

_______________________

1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group

PAUL SCHYVE, Senior Advisor, Quality Improvement, The Joint Commission

ALAN TENNENBERG, Vice President, Global Health Worldwide, Johnson & Johnson

PATRICK WAYTE, Vice President, Marketing and Health Education, American Heart Association

WINSTON WONG, Medical Director, Community Benefit Disparities Improvement and Quality Initiatives, Kaiser Permanente

IOM Staff

LYLA M. HERNANDEZ, Roundtable Director

MELISSA G. FRENCH, Associate Program Officer

ANDREW LEMERISE, Research Associate

ANGELA MARTIN, Senior Program Assistant

ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

SHARON BARRETT, Health Literacy Staff Consultant, Association of Clinicians for the Underserved

RACHEL BRIGHT, Associate Manager, Changing Diabetes Policy, Public Affairs Strategy & Public Policy, Novo Nordisk, Inc.

ALLISON LACE, Nurse Manager, St. Joseph Hospital

PATRICIA ROSSLEY, CLAS Coordinator, AmeriHealth Caritas

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Hugh Tilson, University of North Carolina at Chapel Hill. Appointed by the Institute of Medicine, he was responsible for making certain that an

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
×

independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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Acknowledgments

The sponsors of the Institute of Medicine Roundtable on Health Literacy made it possible to plan and conduct the workshop Discharge Instructions and After-Visit Summaries, which this report summarizes. Sponsors from the U.S. Department of Health and Human Services are the Agency for Healthcare Research and Quality; Health Resources and Services Administration, and the Office of Disease Prevention and Health Promotion. Non-federal sponsorship was provided by California Dental Association; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Humana; Johnson & Johnson; Merck and Co., Inc.; and the UnitedHealth Group.

The roundtable wishes to express its gratitude to the following speakers for their very interesting and stimulating presentations: John Byrne, Darren DeWalt, Benard Dreyer, Alex Federman, Alice Horowitz, Charles Lee, Man Wai Ng, Michael Paasche-Orlow, Ruth Parker, Joshua Seidman, Avniel Shetreat-Klein, Rachel Solotaroff, and Mark Williams.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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Acronyms

ACA Patient Protection and Affordable Care Act
AHRQ Agency for Healthcare Research and Quality

BOOST Better Outcomes by Optimizing Safe Transitions

CMS Centers for Medicare & Medicaid Services
CPRS Computerized Patient Record System

EHR electronic health record

IOM Institute of Medicine
PCP primary care physician
PEMAT Patient Education Materials Assessment Tool

RED Re-Engineered Discharge

SAM Suitability Assessment of Materials

VHA Veterans Health Administration

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Facilitating Patient Understanding of Discharge Instructions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18834.
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The Roundtable on Health Literacy brings together leaders from academia, industry, government, foundations, and associations and representatives of patient and consumer interests who work to improve health literacy. To achieve its mission, the roundtable discusses challenges facing health literacy practice and research and identifies approaches to promote health literacy through mechanisms and partnerships in both the public and private sectors.

To explore the aspects of health literacy that impact the ability of patients to understand and follow discharge instructions and to learn from examples of how discharge instructions can be written to improve patient understanding of-and hence compliance with-discharge instructions, the Roundtable on Health Literacy held a public workshop. The workshop featured presentations and discussions that examined the implications of health literacy for discharge instructions for both ambulatory and inpatient facilities. Facilitating Patient Understanding of Discharge Instructions summarizes the presentations and discussions of the workshop. This report gives an overview of the impact of discharge instructions on outcomes, and discusses the specifics of inpatient discharge summaries and outpatient after-visit summaries. The report also contains case studies illustrating different approaches to improving discharge instructions.

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