Regulatory guide · a review aid, not legal advice
What the evidence says about clear health documents
Low health literacy is tied to more hospital returns, and a redesigned discharge process, clearer written instructions included, cut them in a randomized trial. Whether clearer member letters move Star Ratings or HEDIS has not been studied. Here is what is known, and how to find out on your own members.
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In 30 seconds
- Patients with low health literacy had 1.46 times the rate of 30-day hospital return of those with adequate health literacy.
- A randomized trial of a redesigned discharge process, clearer written instructions included, cut 30-day hospital use by about 30%.
- We found no published study that links plain-language member letters to Star Ratings, CAHPS or HEDIS gains.
- So test it: split one mailing, pick the measure first, and let your data decide.
How many people this affects
In 2003, 12% of US adults had proficient health literacy (NAAL 2003, reported in Kutner et al., NCES 2006-483). These are the latest national figures; the survey has not been repeated. Nationally, 36% of US adults had Basic or Below Basic health literacy. It was more common among the people plans write to: 57% of Medicare enrollees and 60% of Medicaid enrollees.
Low health literacy and hospital returns
A secondary analysis of 703 patients in the usual-care groups of two trials at one urban safety-net hospital measured health literacy before discharge. After adjustment, patients with low health literacy had 1.46 times the rate of readmission or emergency return within 30 days, compared with patients with adequate health literacy. The authors called low health literacy a risk factor that discharge programs can address.
What a redesigned discharge did in a trial
Project RED was a randomized trial of a re-engineered discharge. Patients got an individualized after-hospital care plan, teaching from a nurse discharge advocate and a follow-up call from a pharmacist. Within 30 days, the intervention group had about 30% fewer hospital visits: 0.314 a person a month, against 0.451 with usual care.
- The trial changed the whole discharge process, not only the papers.
- It was run at one academic hospital and was not blinded, so results elsewhere may differ.
- Patients were enrolled in the mid-2000s, and care and payment rules have changed since.
- Both studies come from the same research group and hospital, so they are not independent confirmation.
- Clear written materials were one part of it, and one part a team can control.
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What nobody has proved yet
We found no peer-reviewed study that links plain-language member letters to Star Ratings, CAHPS or HEDIS gains. We found no trial behind any promise of a star, a score or a share of gaps closed. That is a reason to test, not a reason to wait.
How to find out on your own members
Split one mailing. Half get today's letter and half get the revised one. Before it starts, pick the measure, such as gap closure at 90 days, and write the rule that decides. Size matters: to see a rise from 30% to 33%, each group needs about 3,800 people.
How HealthLiteracyCopilot helps
HealthLiteracyCopilot finds the documents most likely to confuse, revises them against N-PLAT, PEMAT and reading grade under your reviewers, and keeps a record of each version. You keep the data and the decision.
Your next step
HealthcareGPS is SOC 2 Type II audited and HIPAA compliant. How we protect your documents
Sources
- Mitchell SE, Sadikova E, Jack BW, Paasche-Orlow MK. Health literacy and 30-day postdischarge hospital utilization. J Health Commun. 2012;17 Suppl 3:325-38, 2012
- Jack BW, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-87, 2009
- NAAL 2003, reported in Kutner et al., NCES 2006-483, 2003
Questions
Will clearer letters raise our Star Rating?
No one can promise that, and no published study shows it. A split mailing on your own members shows whether a clearer letter changes the measure you pick.
Does Project RED prove that clearer handouts cut readmissions?
Not on their own. Project RED changed the whole discharge process: an individualized care plan, nurse teaching and a pharmacist call. Clear materials were one part of it.
How big does a split test need to be?
It depends on the change you want to see. To see a rise from 30% to 33% with standard settings, each group needs about 3,800 people. A bigger expected change needs fewer.