Transcript Slide 1

Creating a User-Friendly Clinic Environment:
The Importance of Health Literacy
Nanette Brey Magnani, EdD, NQC
Evelyn Bradley,DrPH, BCDH, NQC Fellow
Kati Walsh, MSW, ECMC
Funded by HRSA
HIV/AIDS Bureau
Learning Objectives
• Understand that addressing health literacy is in
alignment with national health trends and RW core
values.
• Identify key components and tools of a health literacy
environment assessment and discuss a grantee’s and
consumer’s reaction to their assessment process and
results.
• Share information on health literacy tools for
medication adherence.
• Introduce multi-media programs as patient education
tools.
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National Quality Center (NQC)
Prior Health Literacy Calls and Resources
• www.nationalqualitycenter.org
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National Quality Center (NQC)
Agenda
3:00 Welcome and introductions
3:05 Health Literacy, National Trends, Core Values
3:10 What is a Health Literacy Environment
Assessment?
Grantee experience: Kati Walsh
3:30 Oral Exchange and Print Communication
Evelyn Bradley
3:40 Discussion, Q&A
3:55 Evaluation
4:00 Adjourn
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National Quality Center (NQC)
Health Literacy, National Trends, Core
Values
• Aligning health literacy action with core
values and national direction:
 National HIV/AIDS Strategy – reducing disparities
• Increasing retention
• Increasing access
• Increasing VL suppression
 Consumer involvement – a HRSA/HAB core value
• QI Project level and policy recommendations
• Participation in HL assessments – Walking Interview,
Materials assessment, materials development and
selection
• Materials development: 16th St CHC, Dallas FAN/Youth
Angle Programs
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HL National Trends, core values contd
• Patient Centered Medical Home and Patient Experience
• American Medical Association Foundation
 It is a patient right to understand their disease.
 “Health Literacy and Patient Safety: Help Patients Understand –
Manual for Clinicians.” Barry Weiss, MD, University of Arizona,
College of Medicine.
• Joint Commission Public Policy Initiative
 “What did the Doctor say?”
 E.g. “Make effective communication an organizational priority.”
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HL National Trends, Core Values contd
• Healthy People 2020
 Improve the health literacy of the population
 Increase the proportion of persons who report that
their health care providers have satisfactory
communication skills
 Increase the proportion of persons who report that
their health care providers always involved them in
decisions about their health care as much as they
wanted.
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Looking at Health Literacy in
A Broader Context
Organization
Program
Patient
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Health Literacy Environment
The health literacy environment of a healthcare
organization is the extent to which
communication structures and processes
facilitate access to the information patients
need to manage and make decisions about
their health.”
-Evelyn Bradley, DrPH, BCDH
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Health Literacy Environment:
A Summary of findings by Rima Rudd and Jennie
Anderson
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Components of the Health Literacy
Environment:
1.
2.
3.
4.
5.
Navigation
Print Communication
Oral Exchange
Technology
Policies and Protocols
Rudd RE, Anderson JE. 2007. 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. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p. i.
p.7.
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Screening:
How do we assess the health
care environment of health care
centers?
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Screening Tool
• Rudd & Anderson’s “The Health Literacy Environment of Hospitals
and Health Centers”
 Section II: “The Health Literacy Environment Review”
• Provides rating system for various components of health care
environment, as well as a score calculator and ways to
interpret score
• Appropriate organizational assessment tool questions
 Appendix II: Needs Assessment Tools
• Activities to sensitize health care workers to literacy related
barriers (ie- telephone assessment, walking interview,
materials assessment tools)
• Appropriate as a “self-assessment” tool
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Rating Scale Example: Oral Exchange
Rudd RE, Anderson JE. 2007. 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. Also on
line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.17-18.
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Navigation
1. Navigation
• Telephone system
• Entrance
• Lobby
• Staff Assistance
• Hallways: Navigation Ease
• Services and Specialty Areas (Medical Records,
Pharmacy, MRI, etc).
Rudd RE, Anderson JE. 2007. 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. Also on line at:
www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.9-12.
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Print Communication
2. Print Communication
• Community relations
• Notifications (ie follow up)
• Patient/client orientation
• Patient education materials
• Patient forms
• Legal Materials
• Discharge preparation
Rudd RE, Anderson JE. 2007. 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. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.13-16.
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Print Communication cont’d.
• Materials assessed for:
• Writing Style
• Organization and Design
• Type style, Size of Print, and Contrast with Paper
• Photographs, Illustrations, Symbols and Diversity
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Oral Exchange & Technology
3. Oral Exchange
•
•
staff communication
multilingual providers/translation services
4. Technology
•
•
•
•
Televisions
Telephones
Computers
Kiosks
Rudd RE, Anderson JE. 2007. 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. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net.
p.17-20.
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Policies & Protocols
5. Policies & Protocols
•
Use of Print
• Oral Exchange
• Staff Orientation
• Staff Skills Building (print communication and oral
exchange)
Rudd RE, Anderson JE. 2007. 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. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.21-24.
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Assessment Process: Erie County
Medical Center
• Getting Ready and Pre-work
 Who is involved including Consumer Involvement
 Preparation
 Length of time
 Amount of effort
• Assessment Process
 Pre-work
 Questionnaire analysis
 Walk through
 De-brief
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ECMC’s Results and Follow-Up
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Interventions:
Improving Your HL Environment
• Section III of Rudd’s and Anderson’s
manual gives a listing under each
component of interventions for
developing action plans
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Print Communication and Oral Exchange
Evelyn Bradley, DrPH, BCDH
 Lessons Learned: Consumer Feedback
 Description of two projects:
 Clinic-based PDSA of print and oral
communications applying HL principles
 HIV MMEP
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Learning from Prior Assessment Process:
Feedback from consumers
• It would help if providers:
• Spoke more softly.
• Asked whether you understood.
• Gave you examples.
• Used less jargon, shorter words, shorter
sentences.
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Lessons Learned cont’d.
• Positive Communication techniques
include:
• Repetition.
• Active listening:
• Eye contact,
• Provider asking the patient if they
understand.
• Speaking slowly.
• Being cordial.
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Lessons learned cont’d
• PLWHA’s health literacy capacity goes
beyond consumer “literacy” level.
• Health literacy is a communication issue.
• Very “literate” people can have health
communication issues.
• The health communication issues of both
providers and consumers must be addressed.
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RED LIGHT
 “Do you have any questions?”
 “Do you understand?”
GREEN LIGHT
 “Please explain what you’re
going to do when you get home.”
 “Pretend I am your friend.
Explain to me which pills you
will take when.”
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QI Project 1: Medication Adherence Pilot
Purpose
To improve PLWHA HIV medication
adherence by:
 Ensuring that PLWHA understand why
adherence is important, and
 Providing PLWHA with adherence assistance
tools
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National Quality Center (NQC)
Project 1: Medication Adherence Pilot
Process
• PLAN—Identify HIV adherence support tools:


Accessible to those without strong health literacy
skills
Designed to support HIV medication adherence
• DO



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Modify tools for use by a specific agency
Have one case manager use the tools with 5-10
clients
Administer before and after questions…note that the
“after” questions also serve a teach-back function
National Quality Center (NQC)
QI Project 1: Medication Adherence Pilot
Process
• STUDY
 Document how completely clients answer the questions
 Repeat teach back targeted to areas needing further
learning
 Repeat documentation on learning transference
 Take notes regarding materials and process
• ACT




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if necessary, edit materials and revise process
Encourage dissemination within pilot agency
Make tools available to all EMA providers
Communicate results to other EMA providers
National Quality Center (NQC)
Project 1: Medication Adherence Pilot
Tools
1. “Take Your HIV Medicine Every Day and OnTime,” by Lydia Barakat, Medical Director, Nathan Clinic,
Yale Univ. School of Medicine AIDS Program
2. CD4/VL Chart, by Queen Anne’s Health
Department staff
3. Pill Card, by AHRQ
 All tools were modified to meet partner agency needs.
 Teach-back questions follow exposure to each tool.
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Tool 1: Take Your HIV Medicine
• 11 short adherence messages + illustrations.
• Available in Spanish.
The CD4 T cells in your body
are your friends.
They are like a factory, making things
that protect you from infection
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Las células T ó CD4 en su
cuerpo son sus amigas.
Son como una fábrica,
construyen cosas para
protegerle de infecciones
National Quality Center (NQC)
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National Quality Center (NQC)
Project 2: HIV MMEP Topics
• What is an MMEP and why is an HIV MMEP
needed?
• Purpose: Look for existing HIV MMEPS and identify
HIV topics for 1+ MMEPs
• Process: Literature review and analysis
• Products:
 Spreadsheet and schema of HIV messages offered to
consumers
 Desirable characteristics of an HIV MMEP
• Next steps
• Your insights?
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References – Oral Exchange and Print
Communication
• Roter, D. (2010). From medical dialogue to plain talk: reducing
oral literacy burden by stripping it down, mixing it up and
bringing it home. Proceedings of the Institute for Healthcare
Advancement 2010 health literacy conference Irvine, CA
• DeWalt, D.A. U.S. Department of Health and Human Services,
Agency for Healthcare Research and Quality. (2010). Health
literacy universal precautions toolkit (AHRQ Publication No. 100046-EF). Note: Document only available in electronic format.
Retrieved from
http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf
• Seubert, D. (2010). Improving readability with appropriate
design: seven critical elements. Proceedings of the Institute for
Healthcare Advancement health literacy conference Irvine, CA:
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References
• Agency for Health Care Research and Quality (AHRQ):
Health Literacy Universal Precautions Toolkit, April 2010
Health Literacy Assessment Questions:
http://www.nchealthliteracy.org/toolkit/tool2A.doc
• Rudd RE, Anderson JE. 2007. 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. Also on line at:
www.hsph.harvard.edu/healthliteracy and www.ncsall.net
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National Quality Center (NQC)
Several slides used in this presentation
were part of larger presentations
researched and developed by NYSDOH AI
interns:
Lauren Antler and Sreela Namboordiri
Download: www.nationalqualitycenter.org
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National Quality Center (NQC)
Resources
• www.NationalQualityCenter.org/TACalls
• NQC Quality Academy
 Tutorial 23: Understanding & Addressing Health Literacy
 Tutorial 24: Cultural Competence as a Quality Issue
• AETC National Resource Center website http://www.aidsetc.org/
• TARGET Center website http://careacttarget.org/
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Contact Information
• Nanette Brey Magnani, EdD, [email protected]
• Evelyn Bradley, DrPH, NQC Fellow, Baltimore City
Health Department, [email protected]
• Kati Walsh. Erie County Medical Center, Buffalo, NY.
[email protected]
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National Quality Center (NQC)
212-417-4730
NationalQualityCenter.org
[email protected]
Funded by HRSA
HIV/AIDS Bureau