IMPROVE DISCHARGE INSTRUCTION THROUGH AUTOMATED PICTOGRAPH ENHANCEMENT

描述（由申请人提供）：出院说明为患者管理自己的护理提供了关键信息。这些指示是满足医疗保险和医疗补助服务中心以及医疗保健组织认证联合委员会的认证和公开报告要求的核心措施。然而，研究表明，许多患者不能完全理解他们收到的指示，这种理解的缺乏降低了患者的满意度和依从性。其他因素使患者难以理解和记住指示：身体和情绪困扰、健康素养水平低、缺乏动力和环境干扰。由于这些其他因素不能在出院时消除，研究人员和临床医生探索各种策略，使说明更容易理解。在实践中，护士可能会用外行人友好的术语进行解释，并绘制数字和表格。研究表明，文字简化和象形文字增强是有帮助的，象形文字对低识字率患者尤其有益。在这个项目中，我们将重点关注象形文字的增强。象形文字的好处已经在许多研究中得到证实。然而，有几个问题阻碍了在出院指令中使用象形文字：(1)用象形文字手动增强患者特定指令非常耗时；(2)没有标准的象形文字用于患者沟通；(3)如何系统地开发和评估象形文字用于患者沟通的研究有限。因此，患者特定的出院说明很少包括象形文字，患者仍然难以理解。为了解决这个问题，我们将创建一种面向患者的象形文字语言，并开发一个系统来自动增强具有象形文字的自由文本指令。我们将集中讨论妇科肿瘤学领域。我们的总体目标是提高患者的理解力、满意度和依从性。具体而言，我们将：(1)使用系统的文本分析、象形文字设计和验证方法，为出院说明创建象形文字词汇和语法；(2)通过信息提取和象形文字生成，开发自动化象形文字增强系统；(3)评估自动象形文字增强的安全性和效益。我们将在健康志愿者身上测试该系统的安全性。对患者理解、患者满意度和护士满意度的影响将在布莱根妇女医院的随机对照试验中进行评估。

DESCRIPTION (provided by applicant): Discharge instructions provide critical information for patients to manage their own care. Such instructions are required as core measures to meet accreditation and public reporting requirements by the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations. However, studies show that many patients do not fully understand the instructions they receive and that this lack of comprehension reduces patient satisfaction and compliance. Other factors make understanding and remembering instructions challenging for patients: physical and emotional distress, low health literacy level, lack of motivation, and environmental distractions. Since these other factors cannot be eliminated at the time of discharge, researchers and clinicians explore various strategies to make the instructions more understandable. In practice, nurses may provide explanations in lay-friendly terms and draw figures and tables. Studies have shown that text simplification and pictograph enhancement are helpful and pictographs were especially beneficial for low-literacy patients. In this project we will focus on pictograph enhancement. The benefit of pictographs has been demonstrated in numerous studies. However, several problems inhibit the use of pictographs in discharge instructions: (1) manually enhancing patient-specific instructions with pictographs is prohibitively time consuming; (2) there exists no standard pictographic language for patient communication, and (3) there has been limited research on how to systematically develop and evaluate pictographs for patient communication. As a result, patient-specific discharge instructions rarely include pictographs and remain difficult for patients to understand. To solve this problem, we will create a patient-oriented pictographic language and develop a system to automatically enhance free-text instructions with pictographs. We will focus on the domain of gynecologic oncology. Our overall goal is to improve patient comprehension, satisfaction and adherence. Specifically, we will: (1) create a pictographic vocabulary and grammar for discharge instructions, using systematic text analysis, pictograph design, and validation methods; (2) develop an automated pictograph-enhancement system through information extraction and pictograph generation; and (3) evaluate the safety and benefits of automated pictograph enhancement. We will test the system's safety on healthy volunteers. The impact on patient understanding, patient satisfaction, and nurse satisfaction will be assessed in a RCT with patients at Brigham and Women's Hospital.