Lee M. Sanders, MD, MPH. Stanford University School of Medicine

Transcription

1 Lee M. Sanders, MD, MPH Stanford University School of Medicine

2 Review systemic challenges for promoting child health and well being. Understand parent health literacy as a determinant of some child health outcomes. Discuss clinical and policy strategies to attenuate literacy-related child disparities.

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5 Children are poor because their parents are poor 20% of all children live in poverty 33% of Latino and 38% of Black children 38% of Native American children the Great Recession has moved at least 3 million additional children into poverty. US Census

6 Infant Mortality

7 Functional Limitation due to Chronic Illness Courtesy of Halfon, Houtrow, Larsen, Newacheck, 2011

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9 C u m % E x p e n d it u res % 20% 30% 40% 50% 60% 70% 80% 90% 100% Cum % Patients

10 10% of children accounted for 72% of expenditures 1% of children accounted for 26% of expenditures

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14 The ability to use printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential. U.S. Department of Education 2003

15 53% Intermediate 12% Proficient Below Basic Basic 22% 14% National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, Million Adults with Basic or Below Basic Health Literacy

16 7% Proficient 45% Intermediate Below Basic 25% Basic 23% National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, 2003.

17 93 million (36%)

18 NAAL 2003

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21 N = 358 Kumar, Sanders, et al Acad Ped 2009 Yin, Sanders, et al, in press

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25 Skills / ability Health Literacy Demands / complexity Parker, Ruth. WHCA Health Literacy Action Guide 2009.

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27 Federal Standard (assessed by Lexile and SAM scores)

28 missing necessary marking superfluous markings JAMA 2010

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30 DeWalt, et al. JGIM 2004;19:

31 Rothman et al, Am J Prev Med Cavanaugh et al, Annals of Internal Medicine, 2008

32 *Adj. for SES; **Strong association Sanders, et al. Archives Ped Adol Med, 2009.

33 Health Systems Providers (MDs, RNs) Delivery System Information System Genetics Epigenetics Environment Child Health Needs Family ACTIVATION Child Health Outcomes SES Culture Family Health Literacy Child Caregiver(s) Language Community Systems Schools Social Networks Public Health

34 Child has No Health Insurance 1 Child Not enrolled in TANF/ WIC 2 Health Literacy Below Basic / Inadeq 2.4 ( ) 2.2 ( ) Basic / Marginal 1.7 ( ) 2.4 ( ) Adequate / Proficient 1.0 (ref) 1.0 (ref) 1 Yin, et al. Pediatrics (Adjusted for income, ethnicity, education, age) 2 Pati S, et al. Arch Peds Adolesc Med (Adjusted for income, education)

35 % Subjects All Children with Health Insurance 3% 100 5% % Proficient Health Literacy 95% Intermediate Health Literacy At Least One Child with No Health Insurance 11% 89% Basic Health Literacy p < % 76% Below Basic Health Literacy Yin HS, Johnson M, Mendelsohn AL, Abrams MA, Sanders L, Dreyer BP. The health literacy of parents in the US: A nationally representative study. Pediatrics 2009; 124: S

36 * * Relative Risk N = 276 All Children Children < 5 years old * p=.06, adjusted for parent and child age, gender; parent educational status, and English-language proficiency Sanders, et al. Pediatrics 2006

37 p=0.001 p=0.04 p=0.003 p<0.001 p=0.8 p=0.4 Controlling Prac-ces

38 Dewalt et al, Ambulatory Pediatrics,2007 Ross et al, Diab. Medicine, 2001 Sanders et al, PAS Abstract, 2008

39 Friedland 2002; Vernon 2007

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45 Mika VS 2007

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48 T. Goetz 2010, Wired

49 Teach-Back Technique: Closing the Loop Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman A. Closing the Loop Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med/Vol 163, Jan 13, 2003

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53 Yin et al, Archives of Peds and Adol Med, 2008

54 Research Systematic assessment of literacy burden in 200 pediatric oral liquid OTC medications JAMA 2010 Advocacy CDC/FDA Initiative Single-concentration acetaminophen ml dosing to replace tsp H.R. 338 (Protecting Our Kids Medicine Act), under review

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56 Transforming clinical data (A) and text (B) into familycentered displays (C) to engage parents in clinical decisionmaking for a critically ill child.

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59 California Health Care Foundation

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61 Lower Health Literacy Burden Non Complex Illness Public Schools Basic Education Web-based resources - Self-management - Community agencies Complex Illness Nurse care coordinator Child Health University Peer Support Web-based Resources Higher Health Literacy Burden Child Health University Peer Support Social Worker Web-based Resources Intensive Outpatient Care Home Visit(s) Child Health University Peer Support Nurse care coordinator Social Worker Web-based Resources