Accuracy of Parent Perception of Comprehension of Discharge Instructions: Role of Plan Complexity and Health Literacy
Accuracy of Parent Perception of Comprehension of Discharge Instructions: Role of Plan Complexity and Health Literacy
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DOI：
10.1016/j.acap.2020.01.002
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发表时间：
2020-05-01
影响因子：
3.1
通讯作者：
Yin, H. Shonna
中科院分区：
文献类型：
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作者：
Glick, Alexander F.;Farkas, Jonathan S.;Yin, H. Shonna
目的：住院患者出院教育往往是次优的。家长对出院说明理解程度的测量包括在与发病率相关的国家指标中；很少有研究比较父母的感知理解和实际理解。我们(1)比较了家长对出院指示的感知理解和实际理解；(2)评估了理解高估（感知理解但缺乏实际理解）的计划复杂性与家长健康素养之间的关系。方法：对某城市公立医院住院患者每日1次用药的英语/西班牙语家长（n = 192）进行前瞻性队列研究。我们使用McNemar的测试来比较家长感知（同意/非常同意5分李克特量表）和实际理解（家长报告与医疗记录的一致性）的说明（领域：药物、预约、返回预防措施和限制）。采用广义估计方程来评估低父母健康素养（最新生命体征评分）与父母感知的其他领域理解（95%）之间的关系。实际理解因领域而异（41%-87%），低于感知理解。大多数（84%）家长高估了>= 1域的理解能力。计划复杂性（调整优势比3.6；95%可信区间2.9-4.7）和低健康素养（调整优势比1.9;1.3-2.6）与理解力高估相关。结论：家长对出院指示的感知理解在大多数领域高于实际理解。计划复杂性和低健康素养与对理解的高估有关。未来的干预措施应包括对出院指示的实际理解和标准化的评估。
OBJECTIVE: Inpatient discharge education is often suboptimal. Measures of parents' perceived comprehension of discharge instructions are included in national metrics given linkage to morbidity; few studies compare parents' perceived and actual comprehension. We 1) compared parent perceived and actual comprehension of discharge instructions and 2) assessed associations between plan complexity and parent health literacy with overestimation of comprehension (perceive comprehension but lack actual comprehension).METHODS: Prospective cohort study of English/Spanish-speaking parents (n = 192) of inpatients = 1 daily medication from an urban public hospital. We used McNemar's tests to compare parent perceived (agree/strongly agree on 5-point Likert scale) and actual comprehension (concordance of parent report with medical record) of instructions (domains: medications, appointments, return precautions, and restrictions). Generalized estimating equations were performed to assess associations between low parent health literacy (Newest Vital Sign score 95% of parents perceived comprehension for other domains. Actual comprehension varied by domain (41%-87%) and was lower than perceived comprehension. Most (84%) parents overestimated comprehension in >= 1 domain. Plan complexity (adjusted odds ratio 3.6; 95% confidence interval 2.9-4.7) and low health literacy (adjusted odds ratio 1.9; 1.3-2.6) were associated with overestimation of comprehension.CONCLUSIONS: Parental perceived comprehension of discharge instructions overestimated actual comprehension in most domains. Plan complexity and low health literacy were associated with overestimation of comprehension. Future interventions should incorporate assessment of actual comprehension and standardization of discharge instructions.