title: [On the comprehensibility of German hospital quality reports: systematic evaluation and need for action].
abstract: OBJECTIVE
  This paper focuses on the current resolutions for quality reports of German hospitals as released in 2007 as well as on comprehensibility of these reports for patients. It is meant to analyse the textual information given by these quality reports. Its main objective was to attain a reliable assessment of their comprehensibility for patients on the basis of objective measuring methods. A further goal was to qualify eventual differences between large and small or private and public hospital operators. On the basis of the attained results conclusions on the appropriateness of the current legal situation and the existing criteria for quality reports were to be drawn.
  
  
  METHODS
  The textual system part of 200 German hospital reports was analysed as published in the Internet (latest download 28th May, 2007). The selection took place by means of a controlled sample. The sample structure essentially corresponds to the German hospital system structure in terms of bed numbers and its ratio of public and private operators. The analysis measured all formal text patterns as well as technical terms by means of a computer-aided device. The readability index for each text was calculated according to all known readability formulas for the German language.
  
  
  RESULTS
  German hospital quality reports are readable only for those patients who dispose of above-average communicative skills. The analysed reports contain more than 10% technical terms while 17% of the chosen words and 60% of all sentences are too long. 10% of all sentences are too complex and 25% comprise more than three technical terms. To understand these texts at least an entrance qualification for higher education is required in accordance to readability indices. The texts' degree of complexity is comparable to that of philosophical papers. Most textual information given by German hospital quality reports is proven to be unreadable and incomprehensible for most patients. There are no fundamental differences concerning hospital size and operator.
  
  
  CONCLUSIONS
  The reports' readability and comprehensibility for patients have only scarcely been considered in the current legal resolutions, and there is no undergoing process of improvement. The analysis has shown that there is in fact an urgent need for action. Future reports should therefore ensure that their textual content is formulated in a readable and comprehensible recipient-friendly manner. To enhance customer-oriented transparency within the German public health service patients should be able to fully understand what hospitals want to communicate. Therefore the further process of research will focus on the development of specific criteria for the production of textual reports. This has to be done in co-operation with patients and resident general practitioners.
authors.affiliation: Universität Witten/Herdecke, Fakultät für Medizin, Alfred-Herrhausen-Strasse 50, Witten. JanFriedemann@web.de
authors.forename: J
authors.initials: J
authors.lastname: Friedemann
authors.forename: H-J
authors.initials: HJ
authors.lastname: Schubert
authors.forename: D
authors.initials: D
authors.lastname: Schwappach
mesh_terms: D032882:Comprehension; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000706:statistics & numerical data*; D033181:Information Dissemination / Q000379:methods*; D008499:Medical Records / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012660:Semantics; D014825:Vocabulary; D014956:Writing