Can Generative Artificial Intelligence Enhance Health Literacy About Lateral Epicondylitis?

INTRODUCTION: Health literacy is a critical determinant of a patient's overall health status, and studies have demonstrated a consistent link between poor health literacy and negative health outcomes. The Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) advise that patient educational materials (PEMs) should be written at an eighth-grade reading level or lower, matching the average reading level of adult Americans. The purpose of this study was to investigate the ability of generative artificial intelligence (AI) to edit PEMs from orthopaedic institutions to meet the CDC and NIH guidelines. METHODS: PEMs about lateral epicondylitis (LE) from the top 25 ranked orthopaedic institutions from the 2022 U.S. News & World Report Best Hospitals Specialty Ranking were gathered. ChatGPT Plus (version 4.0) was then instructed to rewrite PEMs on LE from these institutions to comply with CDC and NIH-recommended guidelines. Readability scores were calculated for the original and rewritten PEMs, and paired t-tests were used to determine statistical significance. RESULTS: Analysis of the original and edited PEMs about LE revealed significant reductions in reading grade level and word count of 3.70 ± 1.84 (p<0.001) and 346.72 ± 364.63 (p<0.001), respectively. CONCLUSION: Our study demonstrated generative AI's ability to rewrite PEM about LE at a reading comprehension level that conforms to the CDC and NIH guidelines. Hospital administrators and orthopaedic surgeons should consider the findings of this study and the potential utility of artificial intelligence when crafting PEMs of their own.

Readability Analysis of Patient Education Material on Rotator Cuff Injuries From the Top 25 Ranking Orthopaedic Institutions.

INTRODUCTION: Rotator cuff injuries (RCIs) are incredibly common in the US adult population. Forty-three percent of adults have basic or below-basic literacy levels; nonetheless, patient educational materials (PEMs) are frequently composed at levels exceeding these reading capabilities. This study investigates the readability of PEMs on RCIs published by leading US orthopaedic institutions. METHODS: The top 25 orthopaedic institutions on the 2022 U.S. News & World Report Best Hospitals Specialty Ranking were selected. Readability scores of PEMs related to RCI were calculated using the www.readabilityformulas.com website. RESULTS: Among the 25 analyzed PEM texts, all exceeded the sixth-grade reading level. Only four of 168 scores (2.4%) were below the eighth-grade level. DISCUSSION: This study indicates that PEMs on rotator cuff injuries from top orthopedic institutions are too complex for many Americans, with readability levels ranging from 8.5 to 16th grade, well above the CDC-recommended eighth-grade level. The research highlights a widespread issue with high reading levels across healthcare information and underscores the need for healthcare providers to adopt patient-centered communication strategies to improve comprehension and accessibility. CONCLUSION: PEMs on rotator cuff injuries from leading orthopedic institutions often have a reading level beyond that of many Americans, exceeding guidelines from the NIH and CDC that recommend PEMs be written at an eighth-grade reading level. To increase accessibility, enhance healthcare literacy, and improve patient outcomes, institutions should simplify these materials to meet recommended readability standards.

Evaluation of readability of patient education materials on lateral epicondylitis (tennis elbow) from the top 25 orthopedic institutions.

Hypothesis: Lateral epicondylitis (LE), also known as "tennis elbow," is a common orthopedic tendinosis of the elbow that affects between 1% and 3% of the overall population. LE occurs due to overuse of the extensor mechanism or muscles of supination in the forearm. The National Institute of Health and the Center for Disease Control suggest that patient education materials (PEMs) be written at a 6th or 8th grade reading level, respectively; however, PEMs are often written far beyond these recommended reading levels. The goal of this study was to assess the readability level of PEMs published by some of the top orthopedic institutions throughout the United States. Methods: A list of the top 25 ranking orthopedic hospitals in the country was compiled using the 2022 U.S. News and World Report Best Hospitals Specialty Ranking. PEMs related to LE were cataloged from each institution's website, and readability levels for each PEM were measured using the http://www.readabilityformulas.com website. This software analyzes readability using the formulas listed in Table 1. While the Flesch-Kincaid (FK) Reading Ease Score formula outputs a number from 0 to 100, in which larger numbers indicate easier reading, the remaining formulas demonstrate a text's readability through assigning a grade-appropriate reading level. A Spearman regression was used to evaluate correlation between institutional ranking and FK Reading Ease Scores. Results: Of the 25 PEM texts analyzed during this study, none were written at or below the sixth grade reading level, as recommended by the National Institutes of Health. These results suggest that the most prestigious orthopedic hospitals provide online informational resources that are unable to be read or understood by a large portion of the institution's intended audience. Additionally, there was no correlation found between institutional ranking and FK Reading Ease Score. Conclusion: Internet-based health information has conveniently allowed patients to educate themselves on their health care. In accordance with National Institutes of Health and Centers for Disease Control and Prevention guidelines, orthopedic institutions should strive to publish PEMs at or below an eighth grade reading level.

Postoperative Complications, Readmissions, Lengths of Stay, and Cost Analyses of Patients Who Have Atrial Septal Defects After Total Joint Arthroplasty.

BACKGROUND: Atrial septal defects (ASDs) are a common congenital heart defect. This study aimed to determine whether patients diagnosed with ASDs undergoing total joint arthroplasty have differences in 1) medical complications, 2) readmissions, 3) lengths of stay (LOS), and 4) costs. METHODS: Using an administrative claims data set, a retrospective query from 2010 to 2020 was performed. The ASD patients were 1:5 ratio matched with controls, yielding a total of 45,695 total knee arthroplasty (TKA) (ASD = 7,635, control = 38,060) and 18,407 total hip arthroplasty (THA) (ASD = 3,084, control = 15,323) patients. Outcomes included medical complications, readmissions, LOS, and costs. Logistical regressions were used to calculate odds ratios (ORs) and P values. P values < 0.001 were significant. RESULTS: The ASD patients had higher odds of medical complications after TKA (38.8 versus 21.0%; OR 2.09; P < .001) and THA (45.2 versus 23.5%; OR 2.1; P < .001), noticeably deep vein thromboses, strokes, and other thromboembolic complications. The ASD patients were not significantly more likely to be readmitted after TKA (5.3 versus 4.7%; OR 1.13; P = .033) or THA (6.0 versus 5.7%; OR 1.05; P = .531). Patient LOS was not significantly greater in ASD patients undergoing TKA (3.2 versus 3.2 days; P = .805) but was greater after THA (5.3 versus 3.76 days; P < .001). Same-day surgery costs were not significantly increased in ASD patients after TKA ($23,892.53 versus $23,453.40; P = .066) but were after THA ($23,981.93 versus $23,579.18; P < .001). Costs within 90 days were similar between cohorts. CONCLUSION: The ASD patients have greater 90-day complications following primary total joint arthroplasty. Providers may consider preoperative cardiac clearance or adjusting anticoagulation in this population to mitigate these risks. LEVEL OF EVIDENCE: III.