Addressing Health Literacy to Improve Patient Outcomes. Partnership for Patients Conference April 30, 2013

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1 Addressing Health Literacy to Improve Patient Outcomes Partnership for Patients Conference April 30, 2013 Literacy Coalition of Central Texas, 2012

2 Who We Are Literacy Coalition of Central Texas improves the quality and availability of literacy services to create a community that is 100% literate, employable and engaged. Health Literacy Forward provides QI consulting and trainings for hospitals and clinics on patientcentered care with a focus on effective communication and health literacy.

3 Health Literacy: What it is and Why it s important

4 What is Health Literacy? The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. - Healthy People 2020 Health literacy is a shared responsibility

5 Health Literacy is the currency of success for everything that we do in health, wellness, and prevention. - Richard H. Carmona, M.D., M.P.H., FACS 17 th U.S. Surgeon General

6 Literacy Facts Most health information is written at the 10 th grade reading level or higher, but The average American reads at the 8 th grade level 50% of African-Americans read at or below the 5th grade level 40% of Latinos and senior citizens read at or below the 5th grade level

7 Framing the Issue AMA found that low health literacy is a stronger predictor of a person s health than age, income, employment status, education level and race. AMA estimates 90 million low health literate Americans AHRQ stated, 9 out of 10 Americans may lack the knowledge and skills needed to manage their health and prevent disease.

8 How it feels to be low health literate First, kcehc the egral reppu and rewol rotaidar sesoh 1. What is this passage about? along with the rellams retemaid heater sesoh, hcihw run morf the engine to eht llawerif. Inspect hcae 2. What do you need to do first? esoh along its eritne length, and ecalper any esoh 3. Where can you find the hoses that you need to check first? that is dekcarc, nellows, or swohs signs of noitaroireted. If you ezeeuqs the esoh, skcarc may 4. For what are you inspecting the hoses? emoceb erom apprarent. Make sure the esoh snoitcennoc are tight. Literacy Coalition of Central Texas, 2012

9 What is it like to be a patient with low health literacy? Terry Davis, PhD American College of Physicians Foundation Health Literacy and Patient Safety: Helping Patients Understand. American Medical Association.

10 Health Implications of Low Health Literacy In peer reviewed research, low health literacy has been linked to: Reduced ability to understand labels and health messages Limited ability to follow medication instructions Lower likelihood of accessing/receiving preventive care More hospitalizations Greater use of emergency departments Worse overall health status Higher mortality among the elderly Shorter life expectancy Worse physical and mental health

11 Financial Implications Low health literacy costs $7,500 more per person annually $238 billion annually in the U.S. $685,500,000 in Central Texas 1) Lack of preventative health 2) Overuse of emergency services 3) Longer hospital stays 4) Inability to follow treatment instructions 5) Hospital re-admittance Vernon, John A., PhD. Low Health Literacy: Implications for National Health Policy. Pfizer Health Literacy.

12 Preventable Readmissions 18.7% of patients are readmitted to the hospital with the same or similar condition within 30 days of discharge. 75% of readmissions are preventable. CMS 75% of preventable readmissions are a result of miscommunication. Joint Commission Mean charge per stay for uninsured patient: $22,161 Mean charge per stay for Medicare patient: $38,320 Reducing Medicare and Uninsured patient readmissions by 1% in Texas would save nearly $440,000,000 annually Statistical Brief, 2007 Dept. of State Health Services; Texas Hospital Inpatient Discharge Public Use Data File

13 Becoming a National Priority Improving health literacy will be a major step in the nation s efforts to enhance healthcare quality and safety. - Carolyn Clancy, Director of AHRQ Federal policy has brought us to the tipping point: Affordable Care Act DHHS National Action Plan to Improve Health Literacy Plain Writing Act of 2010; Universal Prescription Med Labels Accountable Care Organizations; PCMH The Joint Commission Use of, right to, and documentation of effective oral and written communication became an accreditation standard Summer, 2012

14 Skills and Resources to Provide Health Literate Care

15 Identifying Instances of Low Health Literacy Make simple communication the standard. Notice warning signs of low health literacy: Behaviors Responses to written information Responses to questions about healthy behaviors Weiss MD, B., et al. Health Literacy and Patient Safety: Helping Patients Understand. American Medical Association

16 Warning Signs of Low Health Literacy Behaviors Responses to Written Information Responses to Behavioral Questions Blank stare Constant nodding in agreement No eye contact Urgency, rushing No questions Dependent on family member I forgot my glasses I ll read it at home Read it to me Eyes don t follow along on page Incorrect or incomplete forms Where do I sign? Deflection, changing the subject Become angry I wasn t told that Unable to complete teach-back Always answer yes or no no elaborating Unable to list meds Literacy Coalition of Central Texas, 2012

17 Oral Communication Tips for Providers AMA s 6 Steps to Improved Interpersonal Communication with Patients Slow down, slow down, slow down Use plain, nonmedical language Show or draw pictures Limit the amount of information provided, and repeat it Use the teach-back method or show-me technique Create a shame-free environment Weiss, Barry D., MD. Health Literacy: A Manual for Clinicians. American Medical Association and American Medical Association Foundation

18 Drop the Medical Jargon! Medical Term Benign Daily Heart Failure Prevention Referral Oral Contraception Plain Language Not cancer Every day Heart isn t pumping well Stopping something from happening Send you to another doctor Birth control pill by mouth Weiss, Barry D., MD. Health Literacy: A Manual for Clinicians. American Medical Association and American Medical Association Foundation

19 Tips to Create Patient-Friendly Materials Patient materials should include: Plain language for technical words One or two syllable words whenever possible Bullet points to present information in bite-sized nuggets Content limited to one or two key objectives and avoid information overload Consistency throughout the form, same font & style Good amount of white space Serif font, size Patient-friendly architecture Weiss, Barry D., MD. Health Literacy: A Manual for Clinicians. American Medical Association and American Medical Association Foundation

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22 Health Literacy Interventions for Healthcare Systems Communication Climate Assessment Toolkit (CCAT) AMA-developed and NQF-endorsed Validated tool evaluates communication environment Identify specific communication gaps to target QI Assess and ensure compliance with accreditation Trainings Your Role in Clear Health Communication Plain-language written materials Patient Empowerment Creating or Adapting Written Materials

23 Additional Resources AHRQ Universal Health Literacy Precautions Toolkit IOM Attributes of a Health Literate Organization AMA Health Literacy and Patient Safety: Help Patients Understand Healthy Roads Media (website for plain-language in many languages) In Texas: Health Literacy Forward

24 Call to Action! Pay attention to detail. How is my patient reacting? Make clear communication the standard Teach your colleagues what you ve learned today! Provide health literacy materials in the waiting room Incorporate health literacy principles into existing initiatives Assess your clinic or hospital for barriers to understanding

25 For most people, medicine is a foreign country, with its own language, customs, and mores. My patients are immigrants to this country, and many feel very disoriented. My job, as their physician, is to translate this alien world for them, to help them acclimatize and hopefully thrive. Danielle Ofri, M.D., Ph.D.

26 Contact Information Find us online! Twitter.com/HlthLitForward Facebook.com/ReachTeachUnite Peter B. Morrison Director of Health Literacy Literacy Coalition of Central Texas, 2012

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