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 the 4th 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: ExitCare recognizes, respects and understands rapid advances that are being made in Medicine and Surgery. These advances impact how we instruct and educate patients about diseases, disease management, health maintenance, prevention, surgical procedures, post-operative care and other critical aspects of many health care needs. In order to keep up with changing practice standards, widely recognized guidelines and evidence-based clinical practice, ExitCare empowers Editors-in-Chief, Clinical Reviewers and the Editorial Staff to trigger revisions and updates as new information becomes available when this information clearly impacts patient education. This being the case, current documents may undergo two different types of revisions:
   1. Scheduled clinical reviews which may occur as often as once a year.  In the absence of new information that directly impacts patient education, ExitCare requests guidance from the Editors-in-Chief and the Medical Reviewers as regards how often scheduled reviews should take place.
   2. "'Triggered' Reviews". These occur outside and irrespective of any regular review interval assigned. Examples include, but are not limited to:
      1. Content update required for compliance with state law (for example, compliance with the 2008 California Medical Facility Infection Control & Prevention Act, SB 1058)
      2. Special Development Needs (for example H1N1)
      3. Announcement of new Guidelines. Examples:
         1. USPSTF
            1. Cervical Cancer Screening
            2. Childhood Obesity (age 6 screening)
         2. AHA/ACC
            1. Stroke - 3 hour TPA window changed to 4.5 hours
            2. CPR (2010). Note that the new 2010 guidelines were the first changes to be made by the AHA/ACC in 5 years.
      4. Core Measures
         1. Venous Thromboembolism
         2. Exclusive Breastfeeding
      5. "Standard of Care" interventions announced. For example, for a number of years, very little has changed as regards focused patient/parent education on the subject of "Neuroblastoma". In the Fall of 2010, new treatment for high risk patients was described and declared as a "New Standard of Care". This announcement is displayed at http://www.medscape.com/viewarticle/729709 and “triggered” a review and update.
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 the ExitCare Board of Directors.)
      1. Works with VP of Medical Content overseeing the development of all phases of medical content.
      2. Works with VP of Medical Content to prioritize the selection of new topics to develop based on recommendations from Editors-in-Chief, end users and clinical Reviewers.
      3. Works with VP of Medical Content to coordinate DMS, editorial review and translation selections.
   2. Vice President, Medical Content
      1. Works directly with CMO as outlined above.
      2. Works closely with the Document Manager and Editors-in-Chief.
      3. Maintains and updates Editorial Guidelines and Training Manual for Authors and Clinical Reviewers.
      4. Works with Document Manager to recruit Clinical Reviewers and coordinate their activities.
      5. On-site visits with Clinical Reviewers and client facilities.
      6. Works with Document Manager in the ongoing development of coordinated processes between the Editorial Team and both Customer Service and Sales.
      7. Works directly with the Director of Clinical Quality Assurance.
   3. Document Manager
      1. Works closely with the Vice President, Medical Content as outlined above.
      2. Manages all aspects of Editorial Team day-to-day operations.
      3. Coordinates and manages collaborative projects with Programming, Customer Service, and Sales.
      4. Manages the Graphics content portion of all new and revised documents.
      5. Processes all invoices from Authors and Clinical Reviewers.
   4. Director of Clinical Quality Assurance
      1. Identification and monitoring (daily) of government resources and publications that represent central repositories for new and revised Core Measures, clinical guidelines, etc.
      2. Works closely with the Document Manager on the implementation, monitoring and revision of Editorial Team Policies and Procedures. 
      3. Works closely with the Document Manager on the development of new Editorial Team Policies and Procedures. 
      4. Continuous monitoring, supervision, and response to Editorial Team-related items logged in the Customer Management System.
      5. Initial “point person” or “triage officer” contact for Customer Service as regards any client issues dealing with document content and/or supporting content.
      6. Document/data integrity
         1. Assure that all standard content language is applied appropriately throughout the entire library.
         2. Assist in the authoring of new language that assures consistency with Core Measures, National Patient Safety Guidelines, the Surgical Care Improvement Project, and other Joint Commission initiatives
         3. Assure that all Joint Commission, etc. language is applied uniformly to all documents where that language is appropriate.
         4. Recommend Document and/or Shortcut naming change where appropriate.
         5. Professional Society Guidelines (AAP, ACEP, ACOG, etc.) applied appropriately.
      7. Clinical review of drafted documents that represent brand new titles specifically written to address Joint Commission and/or regulatory compliance.
      8. Special Projects
   5. Editors-in-Chief ED. One physician Board certified in Adult Emergency Medicine and one physician Board certified in Pediatric Emergency Medicine.
      1. Reviews and edits documents for ExitCareED™ content to meet current best-practice guidelines.
      2. Works 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, performs periodic comprehensive review of the Emergency Department document list.
   6. 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 and the other will focus on Pediatric Inpatient Care.
      1. Reviews and edits ExitCareIP™ content to meet current best-practice guidelines.
      2. Works with CMO, VP of Medical Content and Document Specialist to assign In-Patient topics for review to other medical specialists and healthcare professionals.
      3. When requested, performs periodic comprehensive review of relevant Inpatient document lists.
   7. Editors-in-Chief Ambulatory Care:  Two (2) Board Certified physicians in appropriate medical and/or surgical specialties.  One (1) physician will be focused on Adult Ambulatory Care and the other will focus on Pediatric Ambulatory Care.
      1. Reviews and edits ExitCareAC™ content to meet current best-practice guidelines.
      2. Works 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, performs periodic comprehensive review of relevant Ambulatory Care document lists.
   8. 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, VP of Medical Content and/or Document Manager assign topics.
      3. Document Manager coordinates process.
   9. 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, VP of Medical Content 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 the ExitCare “Training Manual & Guide for Authors”.
   4. The ExitCare Editorial 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, Editor-in-Chief, VP of Medical Content or the Director of Clinical Quality Assurance is responsible for assigning appropriate clinical illustrations and labels to all documents.
   4. The ExitCare Document Manager incorporates appropriate illustration(s) in targeted documents.

Processes

1. English Content Review Process:
   1. Medical Literacy Editors track documents that the Medical Reviewers need to review and will provide appropriate electronic content to these Reviewers.
   2. Editors-in-Chief and Medical Reviewers will review each topic to ensure that the content meets current evidence-based or best-practice guidelines.
   3. The Document Manager and the ExitCare Team will ensure the “Last Reviewed” and “Last Revised” dates are displayed electronically in the document footer.
   4. Medical Literacy Editors will be responsible for user readability to comply with editorial guidelines. Medical 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 Editors-in-Chief, Medical Reviewers, and the VP of Medical Content to assure that the integrity of the clinical content is maintained. 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.
2. Foreign Language Content Review Process:
   1. The Foreign Language Coordinator is responsible for determining when a revision or new content is substantive and requires translation. A substantive change to a document is defined as a wording, phrasing, or sentence structure 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 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. ExitCare will consider customer-generated translations 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.
3. 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, VP of Medical Content and/or Medical Reviewers.
      3. New diseases, vaccines, medical research and treatments.