Health Literacy Update Universal Precautions

Transcription

1 Health Literacy Update Universal Precautions Clinical Advisory Committee June 2013 Chris Reisig, M.A. Project Coordinator, Office of the Medical Director, AIDS Institute

2 Overview - Health Literacy s Continued Relevance - Health Literacy and the QAC - The Shift to Universal Precautions - Next Steps

3 National Assessment of Adult Literacy (2003) Distribution of Health Literacy Levels among English-Speaking Adults in the U.S. Basic 22% Below Basic 14% Proficient 12% Intermediate 52% Nearly nine out of ten Americans adults have some trouble with everyday health information 77 million Americans have significant trouble

4 The Scope of the Problem Low health literacy affects more adults than diabetes, obesity, HIV, AIDS and breast cancer combined It disproportionately affects: Adults over 65 Racial and ethnic groups other than White People with less than a high school degree or GED People living at or below the poverty line Non-native English speakers Leads to an estimated $106-$236 billion in unnecessary healthcare costs annually U.S. Department of Health and Human Services, National Action Plan to Improve Health Literacy (2010)

5 Health Literacy and Health Outcomes A 2011 Annals of Internal Medicine literature review found that low health literacy is consistently associated with: More hospitalizations Greater use of emergency room care Poorer ability to demonstrate appropriate medication usage Poorer ability to interpret labels and health messages Poorer overall health status and higher mortality rates among elderly persons Berkman et al., 2011

6 Health Literacy and HIV/AIDS The same Annals review judged HIV-specific health literacy research to suffer from low strength of evidence However, repeated studies by Kalichman et al. suggest that low health literacy is generally associated with poorer adherence The Health literacy/poor adherence pathway is a continuing area of research

7 Health Literacy, the QAC and AIDS Institute

8 A Brief Timeline Health literacy topics are presented at QAC from June 2009 to December 2010: Health literacy as a patient- and systems-level issue (Namboodiri) The relationship between health literacy and health outcomes (Rudd) Environmental assessment toolkits (Antler) Health literacy as a quality of care measure (Fisher) Health literacy indicator subcommittee formed 2009 Indicators piloted in 2011 Internal AIDS Institute workgroup formed 2010

9 ehivqual Health Literacy Indicators

10 The AIDS Institute s Adopted Definitions The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. U.S. Department of Health and Human Services (2000) Institute of Medicine (2004) Health literacy is the ability to read, understand and act upon health related information. Health literacy also refers to the capacity of professionals and institutions to communicate effectively so that community members can make informed decisions and take appropriate actions to protect and promote health. Office of the Mayor, New York City

11 Health Literacy s Individual and Systemic Components Communication skills of consumer and provider Cultural and social norms Environment Health knowledge Demands of the situation Reading ability Health Literacy Demands of the healthcare system Adapted from U.S. Department of Health and Human Services, Quick Guide to Health Literacy (2006)

12 Universal Precaution

13 A Shift in Emphasis Universal precaution is not a new approach to health literacy Growing consensus that such a paradigm best addresses patients needs and has the potential for sustained quality of care improvement

14 The Prior Emphasis

15 Standardized Screening Rapid Estimate of Adult Health Literacy in Medicine (REALM) REALM-R Short Assessment of Health Literacy for Spanishspeaking Adults (SAHLSA) Test of Functional Health Literacy in Adults (TOFHLA) Newest Vital Sign (NVS) BEHKA-HIV (Not a comprehensive list)

16 The Logic of Health Literacy Screening Health literacy research employs screening and enables quantification of the problem Enables the detection of low health literacy Allows for easy documentation

17 HL Screening Concerns (Practical) Screening takes time in a time-sensitive setting Contact with health environments happens well before screening can occur Screening results does not necessarily translate into changed clinical practice

18 HL Screening Concerns (Conceptual) Patient shame and stigma Uncertainty regarding what screening was exactly measuring Increasing awareness of health literacy s contextual dependency

19 Health Literacy Domains Prose Literacy Document Literacy Numeracy

20 Screening Examples - NVS

21 Screening Examples BEHKA HI

22 HL Screening Concerns (Conceptual) Patient shame and stigma Uncertainty regarding what screening was exactly measuring Increasing awareness of health literacy s contextual dependency

23 Low HL is More Common Than Not Distribution of Health Literacy Levels among English-Speaking Adults in the U.S. Basic 22% Below Basic 14% Proficient 12% If nine out of ten Americans have some trouble with everyday health information, what outcome are we really screening for? Intermediate 52%

24 The Universal Precaution Approach Assumes everyone could use help with health information Considers it the responsibility of the healthcare system to make sure patients understand Focuses on: Making health literacy integral to healthcare organizations mission, structure, and operations Simplifying the literacy requirements of healthcare Training healthcare agents to always communicate effectively

25 Adapted from Ten Attributes of Health Literate Health Care Organizations (IOM 2012) Universal Precaution in Action Leadership Level Staff Level Environmental Level Clinical Level Assign responsibility and authority for health literacy oversight at an executive level Make clear communication an explicit commitment in organizational mission statements Provide health literacy training to clinical and non-clinical staff Continuous evaluate staff on their patient interactions and design remedial training for those in need Create environments with low literacy demands Supply navigation aids (e.g. volunteers, information kiosks, color coding, etc.) Routinely employ teachback and other communication heuristics Redundantly present information (orally, visually and literally) Other key health literacy domains include information systems, consumer advisory mechanisms and transactional transparency.

26 Precipitating Change This shift in emphasis towards universal precautions has resulted from a growing body of literature and federal standards: A Prescription to End Confusion, (IOM 2004) Healthy People 2020 (HHS, 2010) National Action Plan to Improve Health Literacy (HHS, 2010) Standards for Patient-Centered Communication, (JCAHO, 2011) Improving Health Literacy Within a State (IOM, 2011) How Can Health Care Organizations Become More Health Literate? (IOM, 2012) Updated National Culturally and Linguistically Appropriate Services (CLAS) Standards (Office of Minority Health, 2013)

27 A Health Literate Care Model Koh et al. s recent article in Health Affairs (Feb. 2013) exemplifies the shift towards universal precautions A Health Literate Care Model integrates universal precaution strategies into elements of the Chronic Care Model using existing tools and resources

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29 Next Steps

30 Health Literacy at the AIDS Institute The AI Health Literacy workgroup has been reformed. Current areas of focus include: Standardizing health literacy-related language in Requests for Applications and Proposals Training contract managers on universal precautions Other potential areas for consideration: Revisiting the ehivqual indicators Development of a health literacy organizational assessment tool distinct from existing environmental assessment tools

31 Points of Intersection Increasingly, health literacy is being considered in the larger contexts of cultural competency, patient activation and patient engagement

32 Going Forward Consequently, there is a need to emphasize health literacy as a necessary precondition for these more complex concepts. There is also a need for the health literacy field to stay grounded in literacy/numeracy Patient Engagement Patient Activation Cultural Competency Health Literacy

33 Going Forward The identification of effective, evidence-based universal precaution interventions remains paramount Documenting universal precautions will also require additional thought and experimentation

34 Discussion For more information about health literacy, please contact: Chris Reisig Work: (212)

35 Works consulted (1) Antler L. Findings from the Health Literacy Environment Screening Pilot Project. Presentation. 23 June Antler L. The Health Literacy Environment of Hospitals and Health Care Centers: A Summary of findings by Rima Rudd and Jennie Anderson. Presentation. May City of New York (2011). NYC Office of Education: Health Literacy. January 5, 2011, from Davis, Terry C., et al. "Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): A tool to screen adolescents for below-grade reading in health care settings." Pediatrics (2006): e1707-e1714. DeWalt DA, Callahan LF, Hawk V, Broucksou KA, Hink A, Rudd, RE, Brach C Health Literacy Universal Precautions Toolkit. North Carolina Network Consortium and the Cecil G. Sheps Center for Health Services Research. Chapel Hill, NC: University of North Carolina at Chapel Hill. Fortenberry, J. D., et al. "Relation of health literacy to gonorrhea related care." Sexually Transmitted Infections 77.3 (2001): Hawkins AO, Kantayya VS, Sharkery-Asner C Health Literacy: A Potential Barrier in Caring for Underserved Populations. Dis Mon, 56: Institute of Medicine (IOM). Health Literacy: A Prescription to End Confusion. Eds: Nielsen- Bohlman L, Panzer AM, Hamlin B, Kindig DA. Washington, DC: National Academies Press, Jordan JE, Osborne RH, Buchbinder R Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidem, Jul 16.

36 Works consulted (2) Koh, H., Brach, C., Harris, L., and Parchman, M. (2013). A Proposed Health Literate Care Model Would Constitute a Systems Approach to Improving Patients Engagement in Care. Health Affairs, 32 (2): Kutner, M., Greenberg, E., Jin, Y., and Paulsen, C. (2006). The Health Literacy of America s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES ). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Manganello, Jennifer A. "Health literacy and adolescents: a framework and agenda for future research." Health education research 23.5 (2008): Murphy, Debra A., et al. "Health literacy and antiretroviral adherence among HIV-infected adolescents." Patient education and counseling 79.1 (2010): Navarra, Ann-Margaret, et al. "Health Literacy and Adherence to Antiretroviral Therapy Among HIV-Infected Youth." Journal of the Association of Nurses in AIDS Care (2013). Namboodiri S. Health Literacy: Health Literacy Screening Tool Overview. Presentation. 11 Jan Ohl M, Harris A, Nurudtinova D, Xueya C, Drohobyczer D, Overton ET Do Brief Screening Questions or Provider Perception Accurately Identify Persons with Low Health Literacy in the HIV Primary Care Setting? AIDS Patient Care and STDs. 24(10): Osborn CY, Davis TC, Bailey SC, Wolf MS Health Literacy in the Context of HIV Treatment: Introducing the Brief Estimate of Health Knowledge and Action (BEHKA) HIV Version. AIDS Behav. 24:181-8.

37 Works consulted (3) Rudd RE, Anderson JE The Health Literacy Environment of Hospitals and Health Centers. Partners for Action: Making Your Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study of Adult Learning and Literacy. Online at U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.(2006). Quick Guide to Health Literacy. Washington, DC.