With the implementation of the Patient Protection and Affordable Care Act (ACA), the issue of inadequate health literacy has become even more important. Millions of Americans who had been uninsured became eligible on October 1, 2013, to enroll in health insurance plans, and according to early estimates, some 9.3 million more Americans now have health insurance as of March 2014 (Carman and Eibner, 2014). It is unclear, however, whether these individuals possess the necessary skills to compare and choose the health plan that is best for them, to decide among treatment options, and to understand medication and discharge instructions (Peters et al., 2013). “Discharge instructions are often written beyond the comprehension level of patients, and research has shown repeatedly that many patients do not understand the instructions they receive,” said Andrew Pleasant, senior director for health literacy and research at the Canyon Ranch Institute, in his introduction to this workshop. “This is clearly a serious issue that the field of health literacy needs to address.”
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
1The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Institute of Medicine (IOM), and they should not be construed as reflecting any group consensus.
Roundtable on Health Literacy held a 1-day public workshop. An ad hoc committee planned and conducted the workshop, which featured presentations and discussions that examined the implications of health literacy for discharge instructions for both ambulatory and inpatient facilities. 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.
Examples of the topics covered in this workshop include an overview of the impact of discharge instructions on outcomes, the specifics of inpatient discharge summaries and outpatient after-visit summaries, and case studies illustrating different approaches to improving discharge instructions. The members of the roundtable hoped that this workshop would serve to expand the network of those involved in health literacy innovations and problem solving and that it would foster additional dialogue among existing organizations and individuals about the importance of, and the possibilities for, health literacy efforts at many levels.
The workshop (see Appendix A for the agenda) was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning committee comprised Darren DeWalt, Benard Dreyer, Alex Federman, George Isham, and Ruth Parker. This publication summarizes the presentations and discussions that occurred throughout the workshop, highlighting lessons presented, practical strategies, and potential challenges and opportunities for improving discharge instructions. Chapter 2 provides an overview of why there are rules and regulations governing discharge instructions and how they impact health outcomes. Chapter 3 discusses issues germane to inpatient discharge instructions, and Chapter 4 examines issues specific to outpatient after-visit summaries. Chapter 5 examines different approaches to improving health discharge instructions. Chapter 6 recounts the discussion of roundtable members’ comments on lessons learned throughout the workshop.