title: The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study.
abstract: OBJECTIVE
  Recommended as a 'universal precaution' for improving provider-patient communication, teach-back has a limited evidence base. Discharge from the emergency department (ED) to home is an important high-risk transition of care with potential for miscommunication of critical information. We examined whether teach-back improves: comprehension and perceived comprehension of discharge instructions and satisfaction among patients with limited health literacy (LHL) in the ED.
  
  
  METHODS
  We performed a randomized, controlled study among adult patients with LHL, to teach-back or standard discharge instructions. Patients completed an audio-recorded structured interview evaluating comprehension and perceived comprehension of (1) diagnosis, (2) ED course, (3) post-ED care, and (4) reasons to return and satisfaction using four Consumer Assessment of Healthcare Providers and Systems questions. Concordance with the medical record was rated using a five-level scale. We analyzed differences between groups using multivariable ordinal logistic regression.
  
  
  RESULTS
  Patients randomized to receive teach-back had higher comprehension of post-ED care areas: post-ED medication (P < 0.02), self-care (P < 0.03), and follow-up instructions (P < 0.0001), but no change in patient satisfaction or perceived comprehension.
  
  
  CONCLUSIONS
  Teach-back appears to improve comprehension of post-ED care instructions but not satisfaction or perceived comprehension. Our data from a randomized, controlled study support the effectiveness of teach-back in a busy clinical setting. Further research is needed to test the utility and feasibility of teach-back for routine use including its impacts on distal outcomes.
authors.affiliation: Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, MO, USA ; Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA ; Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Griffey
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Shin
authors.affiliation: Meharry Medical College, Nashville, TN, USA.
authors.forename: Solita
authors.initials: S
authors.lastname: Jones
authors.affiliation: Meharry Medical College, Nashville, TN, USA.
authors.forename: Nnenna
authors.initials: N
authors.lastname: Aginam
authors.affiliation: Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, MO, USA ; Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA ; Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Gross
authors.affiliation: Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, MO, USA ; Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA ; Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Yonitte
authors.initials: Y
authors.lastname: Kinsella
authors.affiliation: Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, MO, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Williams
authors.affiliation: Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, MO, USA ; Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA ; Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Carpenter
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis MO, USA.
authors.forename: Melody
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis MO, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kaphingst
keywords: Emergency department; Health literacy; Intervention studies; Physician–patient relations; Teach-back communication