title: Characteristics of outpatient clinical summaries in the United States.
abstract: In the United States, federal regulations require that outpatient practices provide a clinical summary to ensure that patients understand what transpired during their appointment and what to do before the next visit. To determine whether clinical summaries are appropriately designed to achieve these objectives, we examined their content and formatting and their usability. We obtained a convenience sample of clinical summaries from 13 diverse practices across the U.S. and assessed their characteristics using validated measures. We also interviewed key informants at these practices to assess their views of the documents. The summaries were generated by seven different electronic health record platforms. They had small font sizes (median, 10 point) and high reading grade levels (median, 10). Suitability, measured with the Suitability Assessment of Materials was low (median score, 61%) and understandability and actionability, measured with the Patient Education Materials Assessment Test, were fair to moderate (65% and 78%, respectively). Content and order of content were inconsistent across the summaries. Among physicians, 46% found the summaries helpful for clarifying medications while 38% found them helpful for conveying follow-up information. Results suggest that clinical summaries in the U.S. may often be suboptimally designed for communicating important information with patients. A patient-centered approach to designing them is warranted.
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Christopher
authors: C
authors: Salmon
authors: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
authors: Rachel
authors: R
authors: O'Conor
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Sereena
authors: S
authors: Singh
authors: Brookdale Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Ravishankar
authors: R
authors: Ramaswamy
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Joseph
authors: J
authors: Kannry
authors: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
authors: Michael S
authors: MS
authors: Wolf
authors: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: alex.federman@mssm.edu.
authors: Alex D
authors: AD
authors: Federman
mesh_terms: D032882:Comprehension; D003266:Continuity of Patient Care / Q000592:standards*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D057220:Health Literacy; D006801:Humans; D062527:Meaningful Use; D009323:Natural Language Processing; D010045:Outpatients / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010353:Patient Education as Topic; D010820:Physicians; D011932:Reading; D014481:United States
keywords: After visit summary; Electronic health record; Health literacy; Patient centered