ExitCare Editorial Guidelines

1. Health Literacy Standards: Content must be easy-to-read and understand. The standard document content must be at a 6th to 8th grade reading level when possible, based on the Flesch-Kincaid Scale. The content of our "Easy-to-Read" document set must be at a 3rd to 5th grade reading level, based on the Flesch-Kincaid Scale. Criteria include:
   1. Placing special emphasis on easy reading in all documents for the “Home Care Instructions” and “Seek Immediate Medical Care If” sections.
   2. Using a consistent format to improve readability. Format includes:
      1. Section headings.
      2. Bullet points.
      3. Color graphics.
      4. Appropriate use of sufficient "white space."
      5. Standardized titles, phrases and nomenclature.
2. Review Frequency Standards: The Editors-in-Chief and the Medical Reviewers assess the topics annually or once every 2 to 3 years. The criteria for annual review include:
   1. Reviewing the 100 most frequently used patient instructions as defined by customers of ExitCare.
   2. Incorporating new practice guidelines.
   3. Reviewing topics containing time-sensitive materials.
   4. Applying new USPSTF, Joint Commission or other regulatory organization guidelines or suggestions as they are released.
3. Editorial Panel Standards: Specialty and primary care physicians and allied healthcare professionals serve on the editorial panel. The appointments, qualifications and responsibilities of the ExitCare team include:
   1. CMO (Appointed by ExitCare’s Board of Directors.)
      1. Oversees development of all phases of medical content.
      2. Selects new topics from recommendations of end users and reviewers.
      3. Coordinates DMS, editorial review and translation selections.
   2. Editors-in-Chief ED: One (1) Board Certified physician in Adult Emergency Medicine and one (1) Board Certified physician in Pediatric Emergency Medicine.
      1. Review and edit documents for ExitCareED™ content to meet current best-practice guidelines.
      2. Work with CMO, VP of Medical Content, and Document Manager to assign ED topics for review to other medical specialists and healthcare professionals.
      3. When requested, perform periodic comprehensive review of the Emergency Department document list.
   3. Editors-in-Chief InPatient: Two (2) Board Certified physicians in appropriate medical and/or surgical specialties.  One (1) physician will be focused on Adult InPatient Care; the other will focus on Pediatric InPatient Care.
      1. Review and edit ExitCareIP™ content to meet current best-practice guidelines.
      2. Work with CMO, VP of Medical Content and Document Specialist to assign InPatient topics for review to other medical specialists and healthcare professionals. When requested, perform periodic comprehensive review of relevant InPatient document lists.
   4. Editors-in-Chief Ambulatory Care:  Two (2) Board Certified physicians in appropriate medical and/or surgical specialties.  One (1) Board Certified physician will be focused on Adult Ambulatory Care and the other will focus on Pediatric Ambulatory Care.
      1. Review and edit ExitCareAC™ content to meet current best-practice guidelines.
      2. Work with CMO, VP of Medical Content and Document Specialist to assign Ambulatory Care topics for review to other Primary Care specialists and healthcare professionals.
      3. When requested, perform periodic comprehensive review of relevant Ambulatory Care document lists.
   5. Medical Specialty and PCP Reviewers: (Appointed by CMO, VP of Medical Content or Editors-in Chief.) Board Certified physicians in appropriate and relevant primary care, medical and surgical sub-specialties.  Separate and appropriate appointments will be made in Pediatric and Adult sub-specialties.  
      1. Conducts assigned periodic reviews of all relevant topic content to meet current best-practice guidelines.
      2. ExitCare CMO, Editors-in-Chief and Document Manager assign topics.
      3. Document Manager coordinates process.
   6. Allied Healthcare Reviewers: (Appointed by CMO, VP of Medical Content, or Editors-in-Chief). Includes Nutritionists, Physical Therapists, Pharmacists, Nurse Practitioners and Medical Educators.
      1. Reviews assigned document content as required by Medical Specialty and Primary Care Reviewers.
      2. Document Manager, Medical Reviewers and Medical Literacy Editors coordinate process.
4. Peer Review Standards:
   1. In many cases, two (2) physicians review medical content for accuracy and completeness.  In some cases (such as those involving a highly specialized focus,) one physician will review and update the medical content of the assigned document. Decisions regarding this standard are made internally by the CMO and Document Manager.
   2. The ExitCare team uses evidence-based guidelines when available.
   3. Primary resources may include peer-reviewed professional journals and textbooks, CME conference materials, medical software and various clinical websites (government-based, university-based, etc.). Many examples are provided within ExitCare’s “Training Manual & Guide for Authors”.
   4. ExitCare’s Document Management team maintains a database of references used and edits made while reviewing existing and new topics.
5. Medical Illustrations Standards:
   1. Seif and Associates, a Strategic Partner of ExitCare, provides high-resolution medical illustrations.
   2. Non-medical illustrations are created by professional graphic artists solely for use by ExitCare, LLC.
   3. The CMO or Editors-in-Chief are responsible for assigning appropriate illustrations and labels to all documents.
   4. The CMO, Editors-in-Chief and current ExitCare customers request illustrations be included in a specific document. ExitCare’s DMS Administrator incorporates appropriate illustration(s) in the document.

Processes

6. English Content Review Process:
   1. DMS Administrator tracks documents that the Medical Reviewers and Literacy Editors need to review and will provide appropriate electronic content to these reviewers.
   2. Editors-in-Chief and Medical Reviewers review each topic to ensure that the content meets current evidence-based or best-practice guidelines.
   3. The Document Manager and the ExitCare Team ensures the “Last Reviewed” and “Last Revised” dates are displayed electronically in the document footer.
   4. Medical Literacy Editors are responsible for user readability to comply with editorial guidelines. Literacy Editors are non-physicians who are professional, technical and scientific communicators with experience in document usability and the healthcare industry. They work closely with the CMO, Editors-in-Chief and Medical Reviewers to maintain the integrity of the clinical content. As an integral part of the editorial team, the Medical Literacy Editors help to create a document that is grammatically correct and meets ExitCare’s literacy standards. Their duties include:
      1. Using the Flesch-Kincaid Scale analysis as a guide to achieve appropriate reading levels.
      2. Maintaining consistent document formatting.
      3. Editing document copy.
      4. Testing and confirming document usability.
7. Foreign Language Content Review Process:
   1. The CMO and Editors-in-Chief are responsible for determining when the revisions or new content are substantive and require translation.
      1. A substantive change to a document is defined as a modification to any document section that influences the clinical information, instructions, warnings and education provided to the patient, parent, guardian or caregiver.
   2. Substantive content changes in approved languages will be implemented on a quarterly basis by the Foreign Language Document Coordinator.  
   3. Translation services employed by ExitCare must have medical professionals on staff to review the translated work. At least two (2) different translators will translate and proof the document.
   4. Translators will use SDL TRADOS™ or similar translation memory software to ensure that the phrases and sentences are translated in a consistent manner.
   5. After the translation is complete, ExitCare may test the content using independent physicians, nurses or language specialists to determine the quality of the work.
   6. We will consider customer-generated translation in languages currently in ExitCare as well as additional language translations.
   7. Patient Comprehension Questions (an end-of-document patient quiz) are translated into Spanish.
8. New Topics Selection Process:
   1. ExitCare adds new topics each quarter.
   2. The selection of the new topics is primarily driven by:
      1. Requests from ExitCare customers.
      2. Recommendations of CMO, Editors-in-Chief or Medical Reviewers.
      3. New diseases, vaccines, medical research and treatments.