title: Readability of patient education materials available at the point of care.
abstract: BACKGROUND
  Many patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8(th) grade level. Currently, electronic health record (EHR) providers partner with companies that produce PEMs, allowing clinicians to access PEMs at the point of care.
  
  
  OBJECTIVE
  To assess the readability of PEMs provided by a popular EHR vendor as well as the National Library of Medicine (NLM).
  
  
  METHODS
  We included PEMs from Micromedex, EBSCO, and MedlinePlus. Micromedex and EBSCO supply PEMs to Meditech, a popular EHR supplier in the US. MedlinePlus supplies the NLM. These PEM databases have high market penetration and accessibility.
  
  
  METHODS
  Grade reading level of the PEMs was calculated using three validated indices: Simple Measure of Gobbledygook (SMOG), Gunning Fog (GFI), and Flesch-Kincaid (FKI). The percentage of documents above target readability and average readability scores from each database were calculated.
  
  
  RESULTS
  We randomly sampled 100 disease-matched PEMs from three databases (n = 300 PEMs). Depending on the readability index used, 30-100% of PEMs were written above the 8(th) grade level. The average reading level for MedlinePlus, EBSCO, and Micromedex PEMs was 10.2 (1.9), 9.7 (1.3), and 8.6 (0.9), respectively (p ≤ 0.000) as estimated by the GFI. Estimates of readability using SMOG and FKI were similar.
  
  
  CONCLUSIONS
  The majority of PEMS available through the NLM and a popular EHR were written at reading levels considerably higher than that of the average US adult.
authors.affiliation: Mount Sinai School of Medicine, New York, NY 10029-6574, USA. lauren.stossel@mssm.edu
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Stossel
authors.forename: Nora
authors.initials: N
authors.lastname: Segar
authors.forename: Peter
authors.initials: P
authors.lastname: Gliatto
authors.forename: Robert
authors.initials: R
authors.lastname: Fallar
authors.forename: Reena
authors.initials: R
authors.lastname: Karani
mesh_terms: D032882:Comprehension; D004522:Educational Status; D057220:Health Literacy / Q000379:methods / Q000592:standards*; D006801:Humans; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D019095:Point-of-Care Systems / Q000592:standards*