Use of Teach Back to Improve Comprehension of Discharge Instructions for Emergency Patients With Limited Health Literacy

The Impact of Teach-back on Comprehension of Discharge Instructions Among Emergency Patients With Limited Health Literacy: A Randomized, Controlled Study

The purpose of this study was to determine whether use of teach-back discharge instructions improve patient satisfaction and patients' self-reported and objective comprehension of discharge instructions in the emergency department when compared to standard discharge instructions.

Study Overview

• Status: Completed
• Conditions: Conditions Influencing Health Status
• Intervention / Treatment: Behavioral: Teach-back

• Study Type: Interventional
• Enrollment (Actual): 254
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • St. Louis, Missouri, United States, 63110
      • Barnes-Jewish Hospital Emergency Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• patients being discharged from the emergency department
• A score of 6 or less on the Rapid Estimate of Adult Literacy in Medicine, Revised (consistent with Limited Health Literacy)

Exclusion Criteria:

• aphasia,
• non-English speaking,
• mental handicap,
• psychiatric chief complaint,
• too high acuity per physician,
• insurmountable communication barrier,
• evaluations for sexual assault,
• clinical intoxication.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Teach-back; Patients are prompted to state back in their own words their comprehension of the information given to them at discharge.	Behavioral: Teach-back; Patients are asked to repeat back in their own words their understanding of the discharge information that was provided to them.
No Intervention: Standard Discharge Instructions; Patient receives usual discharge instructions as administered by the nurse assigned to the patient.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective comprehension	Concordance between audio taped comprehension compared to review of medical record using 5 level scale of concordance	Questions evaluating comprehension were administered during the discharge interview immediately following discharge from the ED at the index visit (Day 1).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
self-reported comprehension	self reported comprehension of discharge instructions for the following areas: emergency department (ED) course (Tests and treatment); Post-ED care (medication instructions; home instructions; follow-up instructions); Return instructions.	Questions evaluating self-reported comprehension were administered during the discharge interview immediately following discharge from the ED at the index visit (Day 1).

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
patient satisfaction	Patient satisfaction as measured by 4 questions modified from the Consumer Assessment of Health Providers & Systems (CAHPS) Clinician & Group Surveys	Questions evaluating satisfaction were administered during the discharge interview immediately following discharge from the ED at the index visit (Day 1).

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Investigators: Principal Investigator: Richard T Griffey, MD, MPH, Washington University School of Medicine; Principal Investigator: Kim A Kaphingst, PhD, Washington University School of Medicine

Study record dates

Study Major Dates

• Study Start: June 1, 2012
• Primary Completion (Actual): August 1, 2012
• Study Completion (Actual): August 1, 2012

Study Registration Dates

• First Submitted: October 10, 2013
• First Submitted That Met QC Criteria: October 22, 2013
• First Posted (Estimate): October 24, 2013

Study Record Updates

• Last Update Posted (Estimate): October 24, 2013
• Last Update Submitted That Met QC Criteria: October 22, 2013
• Last Verified: October 1, 2013

More Information

Terms related to this study

• Keywords: Health Literacy; Emergency; Teach-back
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 201206011

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No