: We included PEMs from Micromedex, EBSCO, and MedlinePlus. Micromedex and EBSCO supply PEMs to Meditech, a popular EHR supplier in the US. MedlinePlus supplies the NLM. These PEM databases have high market penetration and accessibility
To determine the percentage of PEMs written above target readability, we randomly selected 100 disease/conditionmatched PEMs from each of three databases (n=300 PEMs), and assessed their readability. The target of 100 PEMs was based on proportions assuming 20,000 total PEMs per database with 50% of PEMs above target readability, a 10% margin of error, and α=0.05. PEMs were selected from a web-based alphabetical list via a random numbers
generating program.32 If a disease topic was present in one PEM database but not in the others, the next alphabetical
disease topic on the list was checked against the other two databases until a match was found. This methodology assured the avoidance of particularly obscure topics, and favored the inclusion of common diseases topics such as arthritis, cardiac angina, diabetes, gastroesophageal reflux, and low back pain. Titles, citations, glossaries, and “further resources” listed on each handout were excluded from the readability analysis. In MedlinePlus’ database, multiple resources are listed for each disease. “Patient handouts” and “Easy-To-Read” resources were selected whenever possible. If these were not available, handouts were taken from the “Medical Encyclopedia” or the first listing in the “Overview” category for a given disease. The “alternative names” 1166 Stossel et al.: Readability of Patient Education Materials JGIMcategory at the conclusion of these handouts was excluded from the readability analysis, as it often consisted of lists of medical terms without informational content.