Events at CERGE-EI

Kevin Kloiber

Munich Graduate School of Economics, Germany

Abstract: This paper examines how the complexity of medical discharge instructions influences patient mortality. Using data on 239,878 hospital admissions from a large U.S. academic medical center, I measure textual complexity using standard readability metrics. A one-standard-deviation increase in complexity is associated with a 0.14 percentage point rise in 28-day mortality, representing an 8.7% increase relative to the baseline rate. Associations are highly heterogeneous and concentrated among patients requiring intensive self-management: for heart failure patients, the association is nearly ten times larger. The pattern persists within subsamples of notes containing identical self-care instructions, demonstrating that linguistic framing matters beyond task assignment. By leveraging unstructured clinical text, I measure communication quality, an input in the health production function that has remained largely unobservable in administrative data. The magnitude of the mortality association is comparable to estimates from Medicare eligibility or increased hospital spending, suggesting that interventions to simplify discharge instructions could yield substantial health benefits at low cost.

Full Text: The Cost of Complexity: How Communication Frictions Affect Patient Mortality