Quality Improvement Project: Improving intake forms to make them more readable for patients in an urban clinic setting
Mancuso J, Madigan LM, Kerr H, Rambhatla P. Quality Improvement Project: Improving intake forms to make them more readable for patients in an urban clinic setting. Journal of the American Academy of Dermatology 2018; 79(3):AB236.
Journal of the American Academy of Dermatology
In the landscape of increasing demands on physician and staff time, intake forms are frequently utilized to gather information before the start of the clinical encounter. These forms typically contain information on reason for visit, allergies, current medications, pertinent health history, abbreviated review of systems and important social history. We assessed a sample of the intake forms at our clinic and found that 63% of the time the forms were not filled out at all. A resident poll showed that 75% of residents felt the forms were not useful. We recognized several potential barriers to the forms getting filled out, including lack of clear instructions at the time of check-in, not enough time to fill them out, and importantly, health care literacy. A study from 2003 showed that 36% of U.S. adults had Basic or Below Basic health literacy. Those at risk included adults 65 and older, living at or below the poverty level, with English as a second language, government insurance, and a less formal education. In our urban location of Detroit, Michigan, roughly 47% of adults in Detroit—200,000 total—are “functionally illiterate” meaning they have trouble with reading, speaking, writing, and computational skills. Approximately one-half have a high school diploma or GED. Because of these statistics and the results of our preimplementation survey, our goal was to modify our existing intake form to better suit our needs and the needs of our patients. Our original intake form had an automated readability index of 6, correlating with a fifth grade reading level. We created a more simplified form and removed unclear components. The new intake form had an automated readability index of 5, correlating with a fourth grade reading level, with a one grade level improvement. We assessed a sample of patients in our clinic and 60% said the new form was more “readable” and 80% said they were “more likely to complete” the new form. In addition, 80% of the residents felt the new form helped make the appointment more efficient most of the time. Our plan to keep up the momentum of this QI project is to continue a team approach with participation from the physicians, medical assistants and front desk staff and to recognize that literacy rates vary in our patient population.