SHM Summer Student Research: The Impact Of Plain Language Open Medical Notes On Patient Comprehension

I am Sandeep Bala, a second-year medical student from the University of Central Florida College of Medicine. This summer, I had the pleasure of working on an SHM sponsored research project with my mentor, Dr. Marisha Burden, at the University of Colorado.
Our project is titled “The Impact of Plain Language Open Medical Notes on Patient Comprehension”. We sought to understand patients’ perception of plain-language simplified open medical notes and their impact on comprehension.
As demonstrated by previous studies, providing patients access to their encounter notes improves patient adherence to the treatment plan, increases patient participation in care, reduces medical errors, fosters patient trust, and makes clinical visits more efficient.
However, a major barrier to the utility of open medical notes has been the dense medical terminology which makes it difficult for most patients to sufficiently understand their notes. Using technology to simplify the note to a language that is more accessible to patients may be an effective solution to this challenge.  

In our study, we used artificial intelligence software to simplify a standardized cardiology patient note to a fifth-grade level reading language. Study participants were selected from hospitalized patients from UCHealth Anschutz Hospital. We sought to understand patient perception of the simplified note through individual guided interviews with study participants. We also collected demographic information and administered a comprehension quiz to groups receiving either the simplified or unsimplified versions of the standardized note.
In the guided interviews, all participants interviewed stated that access to simplified medical notes would help them to better manage their health. Three broad themes emerged from the discussion: (1) increased understanding, (2) improved communication, and (3) enhanced patient-provider relationship. The discussion also revealed important strategies to enhance the usefulness of simplified notes.

Increased understanding – Participants frequently expressed a desire for their physicians to make a better effort to help the patient understand their conditions and management plan. Many reported that they always have more questions after a visit to the doctor. One participant stated, “sometimes doctors use language that they don’t realize is above our level, so having a simplified resource helps". Another stated, “things can get lost during a medical visit because you may be anxious, or the information may come too fast. Having a note like this to reference later is very useful.” Participants felt that the enhanced understanding would also help them to be more autonomous, rather than to rely on family members to explain to them their medical problems.
Improved communication – Participants desired an accessible note which would empower them to talk about their medical problems and management. Some participants expressed that they often do not ask questions during their visit because they feel embarrassed about their lack of knowledge. They felt that a note would help them ask more questions. Participants shared that they would be able to better discuss their medical conditions with their family and make joint decisions. Furthermore, participants shared that this would help them explain their circumstances to their employers and request accommodations or leave at work.

Enhanced patient-provider relationship – Many felt that this note would enhance their relationship with their health care provider.  Participants would have more confidence in providers who gave them simplified notes. They felt that it would show that the provider cared about their understanding and participation. Some participants would be more likely to attend their follow ups and comply with what their physicians asked them to do if they understood why. A subset of participants felt that that physicians do not consider their opinions to be important. "Some docs are condescending which makes me not want to ask questions and instead look things up on my own," reported one patient. He or she would feel more empowered with a note that bridges this gap.
Statistical analysis of the demographic data collected on patients was unable to show a significant difference between the two groups in the number of questions answered correctly. However, statistical analysis was limited by our limited sample size (n = 20) and the short quiz (seven questions).

Future studies would incorporate the insight on improving the simplified note itself and ask more questions with a larger sample size. I hope to be involved in continuing to help improve the software to generate these simplified notes and the research on its impact. I look forward to presenting our insights the SHM conference and my medical school’s annual research conference.
I had an excellent experience working on this research project with the Hospital Medicine team at the University of Colorado this summer. Dr. Burden went above and beyond to make sure that I had an enriching experience learning about hospital medicine. Thanks to this support from SHM, I was able also able to learn about healthcare leadership and quality improvement through the Health Innovations Scholars Program during my time there.

Posted by Sandeep Bala on Nov 5, 2018 8:57 PM America/New_York