Evaluating the quality and equity of patient hospital discharge instructions

BACKGROUND: Written discharge instructions improve patient understanding and self-management after hospitalization. While a small number of studies have evaluated the quality of hospital discharge instructions, none have focused on patients with a non-English language preference (NELP) or looked for potential disparities. Our goal was to compare the quality of patient discharge instructions between those with English language preference and NELP, including whether instructions were in the patient's preferred language, included all content domains recommended by professional groups, and followed best practices for health literacy. METHODS: We analyzed 200 discharge records from inpatient adult medicine discharges at one hospital across a range of diagnoses using case matching by diagnosis and age to construct an English and NELP cohort (each n = 100). We assessed the percentage of discharge instructions written in the patient's preferred language, measured word count, and calculated readability scores. Lastly, two individual raters used a scale-the Quality of Discharge Instructions-Inpatient (QDI-I) scale-to rate them across six domains of content quality. RESULTS: Only 8% of patients with NELP received discharge instructions in their preferred language compared to 100% in the English cohort (p < 0.001). The mean overall QDI-I score was similar for the NELP and English cohorts (71.1% of perfect versus 71.3% of perfect, p = 0.92), but the domain of return precautions was inferior among those with NELP (80.5% of perfect vs. 88.8% of perfect, p = 0.013). Instructions in both groups were written at an eighth- to ninth-grade reading level (age 13-15). DISCUSSION: We found disparities in quality of written discharge instructions for patients with NELP. Recommended next steps include replication of our methods across health systems and larger sample sizes to examine differences between non-English language groups.