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Schwarz CM, Hoffmann M, Smolle C, Borenich A, Fürst S, Tuca AC, Holl AK, Gugatschka M, Grogger V, Kamolz LP, Sendlhofer G. Patient-centered discharge summaries to support safety and individual health literacy: a double-blind randomized controlled trial in Austria. BMC Health Serv Res 2024; 24:789. [PMID: 38982360 DOI: 10.1186/s12913-024-11183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/06/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND To ensure a safe patient discharge from hospital it is necessary to transfer all relevant information in a discharge summary (DS). The aim of this study was to evaluate a bundle of measures to improve the DS for physicians, nurses and patients. METHODS In a double-blind, randomized, controlled trial, four different versions of DS (2 original, 2 revised) were tested with physicians, nurses and patients. We used an evaluation sheet (Case report form, CRF) with a 6-point Likert scale (1 = completely agree; 6 = strongly disagree). RESULTS In total, 441 participants (physicians n = 146, nurses n = 140, patients n = 155) were included in the study. Overall, the two revised DS received significant better ratings than the original DS (original 2.8 ± 0.8 vs. revised 2.1 ± 0.9, p < 0.001). Detailed results for the main domains are structured DS (original 1.9 ± 0.9 vs. revised 2.2 ± 1.3, p = 0.015), content (original 2.7 ± 0.9 vs revised 2.0 ± 0.9, p < 0.001) and comprehensibility (original 3.8 ± 1.2vs. revised 2.3 ± 1.2, p < 0.001). CONCLUSION With simple measures like avoiding abbreviations and describing indications or therapies with fixed contents, the DS can be significantly improved for physicians, nurses and patients at the same time. TRIAL REGISTRATION First registration 13/11/2020 NCT04628728 at www. CLINICALTRIALS gov , Update 15/03/2023.
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Affiliation(s)
- Christine Maria Schwarz
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital of Graz, Auenbruggerplatz 1/3, Graz, EG, A-8036, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria.
- Executive Department for Quality and Risk Management, University Hospital of Graz, Auenbruggerplatz 1/3, Graz, EG, A-8036, Austria.
| | - Christian Smolle
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Stefan Fürst
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexandru-Cristian Tuca
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
| | - Anna Katharina Holl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Gugatschka
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Victor Grogger
- Department for Medical Informatics and Processes, University Hospital of Graz, KAGes, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital of Graz, Auenbruggerplatz 1/3, Graz, EG, A-8036, Austria
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Nielsen MS, Steinsbekk A, Nøst TH. Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study. JMIR Ment Health 2024; 11:e57965. [PMID: 38860592 PMCID: PMC11185290 DOI: 10.2196/57965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
Background In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals' digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions A total of 17 recommendations related to key aspects of health care professionals' digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice.
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Affiliation(s)
- Martine Stecher Nielsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, Clinical Research Facility, St. Olavs hospital, Trondheim, Norway
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Zaretsky J, Kim JM, Baskharoun S, Zhao Y, Austrian J, Aphinyanaphongs Y, Gupta R, Blecker SB, Feldman J. Generative Artificial Intelligence to Transform Inpatient Discharge Summaries to Patient-Friendly Language and Format. JAMA Netw Open 2024; 7:e240357. [PMID: 38466307 DOI: 10.1001/jamanetworkopen.2024.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Importance By law, patients have immediate access to discharge notes in their medical records. Technical language and abbreviations make notes difficult to read and understand for a typical patient. Large language models (LLMs [eg, GPT-4]) have the potential to transform these notes into patient-friendly language and format. Objective To determine whether an LLM can transform discharge summaries into a format that is more readable and understandable. Design, Setting, and Participants This cross-sectional study evaluated a sample of the discharge summaries of adult patients discharged from the General Internal Medicine service at NYU (New York University) Langone Health from June 1 to 30, 2023. Patients discharged as deceased were excluded. All discharge summaries were processed by the LLM between July 26 and August 5, 2023. Interventions A secure Health Insurance Portability and Accountability Act-compliant platform, Microsoft Azure OpenAI, was used to transform these discharge summaries into a patient-friendly format between July 26 and August 5, 2023. Main Outcomes and Measures Outcomes included readability as measured by Flesch-Kincaid Grade Level and understandability using Patient Education Materials Assessment Tool (PEMAT) scores. Readability and understandability of the original discharge summaries were compared with the transformed, patient-friendly discharge summaries created through the LLM. As balancing metrics, accuracy and completeness of the patient-friendly version were measured. Results Discharge summaries of 50 patients (31 female [62.0%] and 19 male [38.0%]) were included. The median patient age was 65.5 (IQR, 59.0-77.5) years. Mean (SD) Flesch-Kincaid Grade Level was significantly lower in the patient-friendly discharge summaries (6.2 [0.5] vs 11.0 [1.5]; P < .001). PEMAT understandability scores were significantly higher for patient-friendly discharge summaries (81% vs 13%; P < .001). Two physicians reviewed each patient-friendly discharge summary for accuracy on a 6-point scale, with 54 of 100 reviews (54.0%) giving the best possible rating of 6. Summaries were rated entirely complete in 56 reviews (56.0%). Eighteen reviews noted safety concerns, mostly involving omissions, but also several inaccurate statements (termed hallucinations). Conclusions and Relevance The findings of this cross-sectional study of 50 discharge summaries suggest that LLMs can be used to translate discharge summaries into patient-friendly language and formats that are significantly more readable and understandable than discharge summaries as they appear in electronic health records. However, implementation will require improvements in accuracy, completeness, and safety. Given the safety concerns, initial implementation will require physician review.
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Affiliation(s)
- Jonah Zaretsky
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
| | - Jeong Min Kim
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
| | | | - Yunan Zhao
- Department of Population Health, NYU Langone Health, New York
| | - Jonathan Austrian
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
- Department of Health Informatics, NYU Langone Medical Center Information Technology, New York
| | - Yindalon Aphinyanaphongs
- Department of Population Health, NYU Langone Health, New York
- Predictive Analytics Unit, NYU Langone Health, New York
| | - Ravi Gupta
- Department of Internal Medicine, Long Island Community Hospital, NYU Langone Health, New York
| | - Saul B Blecker
- Division of Hospital Medicine, Department of Medicine, NYU (New York University) Langone Health, New York, New York
- Department of Population Health, NYU Langone Health, New York
| | - Jonah Feldman
- Department of Medicine, NYU Long Island School of Medicine, Mineola
- Department of Health Informatics, NYU Langone Medical Center Information Technology, New York
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Aries AM, Bailey P, Hunter SM. The mutual benefits of patient and public involvement in research: an example from a feasibility study (MoTaStim-Foot). RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:87. [PMID: 34863297 PMCID: PMC8645133 DOI: 10.1186/s40900-021-00330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Patient and public involvement (PPI) in research has increased steadily over the last two decades and is now both expected and appropriately resourced by many funding bodies, including the National Institute for Health Research (NIHR). However, PPI in research occurs in many different capacities and numerous frameworks exist for reporting or appraising patient involvement activities. The aim of this article is to describe processes involving PPI contributions to an NIHR-funded mixed-methods feasibility study (MoTaStim-Foot). Details of PPI advisors' input, from initial identification and prioritisation of research ideas, to research delivery and dissemination, are discussed. METHODS Extensive PPI for MoTaStim-Foot is reported, with consideration of Research Design Service (RDS) advice for PPI for research, involving identifying and prioritising: design; grant proposal development; undertaking/managing research; analysing and interpreting; dissemination; implementation; monitoring and evaluation. Two PPI workshops were undertaken; success in meeting UK standards for public involvement was audited against specific success criteria by two researchers, with discussion and consideration regarding how well our PPI achieved inclusive opportunities, working together, support and learning, governance, communications and impact. How PPI can be improved for future trials was also considered. Although the advantages of PPI for researchers were considered, the benefits for PPI advisors were also analysed. RESULTS UK standards for public involvement were achieved, along with seven relevant research processes suggested by the RDS. PPI advisor contributions: informed study design; contributed to successful funding; enhanced trial delivery by informing participant information sheets and daily diaries; added value through undertaking note-taker roles in focus groups and helping to analyse focus group transcripts; and assisted in dissemination. However, benefits were mutual with PPI advisors reporting feeling valued and respected, a sense of pride with renewed confidence and purpose in life. CONCLUSIONS Importance and value of PPI, to researchers and patient advisors, have been highlighted, reinforcing the benefits of working in partnership with PPI advisors. Trial registration ISRCTN 13676183; Central Portfolio Management System ID 30449. Registered 02/01/2015, https://www.isrctn.com/ISRCTN13676183 .
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Affiliation(s)
- Alison M Aries
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - Paul Bailey
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Susan M Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
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