Transcript Ask Me 3 Presentation

Advancing Clear Health
Communication to Positively
Impact Health Outcomes
Presentation Sections
 The Problem: Low Health Literacy – Scope and Impact
 Finding a Solution
– The Partnership for Clear Health Communication
– Ask Me 3
 How to Become Involved: Solutions into Action
The Problem:
Low Health Literacy
Scope and Impact
Do You Know Which Critical Public Health Issue…
 Impacts nearly one in every three people
living in the United States
 Can hit any population segment, regardless
of age, race, education or income
 Costs the healthcare system as much
as $58 billion a year
 Can’t be diagnosed by any new medical
technology and is not visible to the eye
Answer:
Low Health Literacy
The Issue: Low Health Literacy
 What is health literacy?
– The ability to read, understand and act
on health information
How Big Is the Problem?
More Than 90 Million People in the US Have Difficulty Reading
Approximately 40 to 44 Million
Adults in the US Are
Functionally Illiterate1
Cannot Perform
Basic Reading
Tasks Required to
Function in Society
Approximately 50 Million
Are Marginally Illiterate1
Have Trouble
Reading Maps and
Completing
Standard Forms
Average Reading Skills of
Adults in the US Are Between
the 8th and 9th Grade Levels2
Sources:
1 Kirsch et al., “A First Look at the Results of the National Adult Literacy Survey” Nat’l Center for Education Statistics, 1993
2 Stedman L, Kaestle C. Literacy and Reading Performance in the US From 1880 to Present. In: Kaestle C, Editor.
Literacy in the US: Readers and Reading Since 1880. New Haven (CT): Yale University Press; 1991. P. 75–128
Reading Levels & Skills
60
50
50
40
30
20
32
18
10
0
1
0-5
2
6-9
3
10-16+
Functional Competency
Reading Grade Level
% in Level
% of US Population
Reading Skills
35
30
25
20
15
10
5
0
28
31
23
15
3
1
2
3
Levels
4
5
How Does Low Health
Literacy Affect Your Practice?
 Chances are high that some of your patients are
among the 90 million who have low health literacy
 You may not know that patients with poor health
literacy skills are in your care:
– They use well-practiced coping mechanisms that
effectively mask their problem
– They are often ashamed to admit they have difficulty
understanding information and instructions
Defining the Problem Scope
Coping Mechanisms for Patients With Low Literacy
Ask Other Patients
Ask for Help From Medical Staff
Watch and Copy Others’ Actions
Bring Someone Who Can Read
Source: Parikh et al., 1996
80%
90%
88%
98%
Who Is at Risk for Low Health Literacy?
 Anyone in the US – regardless of age, race,
education, income or social class – can be at risk for
low health literacy
– Ethnic minority groups are disproportionately affected
by low health literacy
– The majority of people with low literacy skills in the US
are white, native-born Americans
– Older patients, recent immigrants, people with chronic
diseases and those with low socioeconomic status are
especially vulnerable to low health literacy
Low Health Literacy Impacts a Patient’s Ability
to Fully Engage in the Healthcare System
The Largest Study Conducted to Date
on Health Literacy Found That…
33% Were unable to read basic health care materials
42% Could not comprehend directions for taking
medication on an empty stomach
26% Were unable to understand information on an
appointment slip
43% Did not understand the rights and responsibilities
section of a Medicaid application
60% Did not understand a standard informed consent
Source: Williams MV, Parker RM, Baker DW, et al. Inadequate Functional Health Literacy Among Patients
at Two Public Hospitals. JAMA 1995 Dec 6; 274(21):1,677–82
Low Health Literacy Negatively Impacts
Health Outcomes
 Adults with low health literacy:
– Are often less likely to comply with prescribed treatment and self-care regimens1
– Make more medication or treatment errors1
– Fail to seek preventive care1
– Are at a higher risk for hospitalization than people with adequate literacy skills 2
– Remain in hospital nearly 2 days longer3
– Lack the skills needed to negotiate the health care system1
 People with low health literacy AND diabetes:
– Were found to be less likely to have effective glycemic control4
– Were more likely to report vision problems caused by their diabetes4
1
Weiss, BD. 20 Common Problems in Primary Care. McGraw Hill. December 1999
Baker DW, Parker RM, Williams MV, Clark WS. Health Literacy and the Risk of Hospital Admission. Journal of General Internal Medicine.
1998; (13): 791-798.
3
Kirsch IS, Jugebut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey.
Washington, DC: Department of Education 1993.
4
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB. Association of Health Literacy
With Diabetes Outcomes. JAMA. July 24/31 2002 (288) No 4.
2
Low Health Literacy
Impacts Resource Utilization
 Adults with low literacy:
– Averaged 6% more hospital visits1*
– Stayed in the hospital nearly 2 days longer than
adults with higher literacy skills1*
– Had fewer doctor visits, but used significantly more
hospital resources2
– Had annual health care costs 4 times higher than
those with higher health literacy3
•Among adults who stayed overnight in a hospital
1
Kirsch IS, Jugebut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey.
Washington, DC: Department of Education 1993.
2
Baker DW, Parker RM, Williams MV, Clark WS. Health Literacy and the Risk of Hospital Admission. Journal of General Internal Medicine.
1998; (13): 791-798.
3
Weiss, BD. 20 Common Problems in Primary Care. McGraw Hill. December 1999.
Implications of Low Health Literacy
 Poor Health Outcomes
 Under-utilization of preventive services
 Over-utilization of health services
 Unnecessary health care expenditures
 Limited effectiveness of treatment
 Needless patient suffering
 Higher patient dissatisfaction
 Higher provider frustration
You Can’t Tell By Looking
Finding a
Solution
Solutions:
Focus on Care Providers and Materials
Differences between good and poor readers…
and how you can manage problems
SKILLED READERS
POOR READERS
MANAGING THE
PROBLEMS
Interpret meaning
Take words literally
Explain the meaning
Read with fluency
Read slowly, miss meaning
Use common words, examples
Get help for uncommon words
Skip over the word
Use examples, review
Grasp the context
Miss the context
Tell context first, use visuals
Persistent reader
Tire quickly
Short segments, easy layout
The Patient-Provider Relationship
There Is a Disconnect Between Patient and Provider:
Bridging the Information Gap Will Help Improve Health Literacy
70% of physicians say
they provide patients
with additional resources
to help them understand
their medications
But just 41% of those
patients say they have
received this kind
of assistance
75% of physicians report
patients have trouble
understanding Rx information
17% of patients report
trouble understanding
Rx Information
Source: Health Literacy & The Prescription Drug Experience: The Front Line
Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002
Why is this?
Short-term memory
 Short-term memory has very limited capacity and short storage time
 Most people can store 7 or fewer independent items at one time
 This memory lasts less than 1 minute
Long-term memory
 Long-term memory lasts for days and years
 Long-term memory has no practical capacity limits
 To move into long-term memory, use association and interaction
Getting Into Long-term Memory
Short-term memory
• Gain the patient’s attention
• Present no more than seven items at a time
• Get to the point
Long-term memory
•Associate new information with what patient already knows
•Involve the patient in interaction with the information
•Repeat or review
Written Communication
Making Health Information Understandable
Written
 87% report reading Rx information
 Yet only 34% believe others
read this same information
 50% of adults read at below
 Consumer healthcare
8th grade reading levels
materials written at
10th grade or above,
where only 50MM can
understand and act
 20% of adults read at below
5th grade reading levels
 40% of seniors read at below
5th grade reading levels
What Do We Do?
Develop Written Materials at 6th Grade or Below,
Where 160MM Can Understand and Act
Source: Health Literacy & The Prescription Drug Experience: The Front Line
Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002
Example of Health Communication That
May Not Reach a Broad Consumer Audience
70
150
Good
Range
Too
Low
Too
High
What You Need to Know About Low Blood Sugar
Blood Sugar
Is Too Low if
It Is Under 70
Blood Sugar
Is Too High if
It Is Over 240
9th Grade
Reading Level
Treat low blood sugar quickly. If you have signs of
low blood sugar, eat or drink something that has sugar
in it. Some things you can eat are hard candy, sugarsweetened soda, orange juice, or a glass of milk.
Special tablets or gel made of glucose (a form of
sugar) can be used to treat low blood sugar. You can
buy these in a drug store. Always have some of these
items handy at home or with you when you go out in
case your blood sugar drops too low. After treating a
low blood sugar reaction, eat a small snack like half
a sandwich, a glass of milk, or some crackers if your
next meal is more than 30 minutes away.
Source: The National Institute of Diabetes and
Digestive and Kidney Diseases
Example of Clear Health Communication –
That Reaches a Broad Consumer Audience
 Common visual used
to explain concept
 Uses action captions
that clarify the point
of the visual
 Creates interaction
with the reader
Verbal Communication
Up to 80% of Patients Forget What Their Doctor Tells Them As
Soon As They Leave the Doctor’s Office – AND
Nearly 50% of What They Do Remember is Recalled Incorrectly
Patients experience shame around the issue
 Only 14% of patients say they feel awkward admitting they don’t
understand; yet 79% feel others don’t understand
Providers experience time challenges
 Providers interrupt patients 30 seconds after they start speaking;
if not interrupted, patients will speak less than two minutes
What Can We Do?
Communicate Effectively
Source: Health Literacy & The Prescription Drug Experience: The Front Line
Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002
Reaching the Solution
In the Office - Best Opportunity for Immediate Impact
1. Tell patients that instruction is aimed at solving/managing their
health problem. Ask what they know, then outline topics you plan to cover.
2. Get to the point quickly.
Low literacy skills = short attention span.
3. Ask patients to solve a problem with the new information. Ask them to
tell or show you how they will use the information just learned.
Limited Education Objectives (example)
Objectives (for patient)
1. Understand what
hypertension is
2. Follows medication
regimen
“Must Include” Topics
What is hypertension &
what is patient’s BP?
Interactive Questions
What is HBP?
What is your blood
pressure?
Dangers of hypertension What are some dangers
to you from HBP?
Taking medicine can
control hypertension
How can you lower your
blood pressure?
Must take medication
every day even if you
What about taking
feel okay
medication on days you
feel okay?
Choosing the Right Words
 Concept words describe a general idea or abstract
framework (i.e. eat a ‘variety’ of foods; keep your glucose
level within a ‘normal range’) = often misunderstood
 Category words describe groups of things; people with
low literacy skills have trouble understanding categories
 Value judgment words (i.e. ‘excessive’ bleeding; exercise
‘regularly’); need to be specific
 Use examples of common ideas to explain uncommon
words
 Use visuals/pictures to emphasize or clarify
Reaching the Solution
Guidelines for Health Education
1. Set realistic objectives.
Use a planning sheet to write down key points.
2. To change health behaviors, focus on behaviors and skills.
Emphasize skills, rather than facts.
3. Present context first (before giving new information). State the use for
new information before presenting it; relate it to context of patients’ lives.
4. Partition complex instructions.
Break instruction into easy-to-understand
parts. Provide opportunities for small successes.
5. Make it interactive.
Consider including an interaction after each key topic. The
patient must: write, tell, show, demonstrate, select or solve a problem.
Clear Health Communication –
We Can All Be a Part of the Solution
 Even if you are not in a position to directly answer
the three questions, keep clear health communication
in mind and in your dialogue when communicating
with patients
 Many people have trouble understanding medical terms.
Often, these terms are better understood when
explained with common words, an example or
visual interpretation
Clear Health Communication in Action
Start by Decreasing the Use of Medical Jargon
Instead of
Using This Word
Consider Using
This One Instead
Benign
Chronic
Cardiac
Harmless
Happens again and again; does not end
Heart
Edema
Fatigue
Screening
Intake
Generic
Swelling; build up of fluid
Tired
Test
What you eat or drink
Not a brand name
Adverse events
Side effects
Finding a Solution
The Partnership’s First Solution
 Addresses awareness and education
 Creates a Call to Action for patients and providers
 Is designed to promote clear communication between
patients and providers to improve health outcomes
 Was developed with health literacy experts,
then tested and validated
Ask Me 3
 Use of Ask Me 3 resulted in reduction in 30 day readmission rates for
heart failure pts. (7.2% to 2.5%)
 Patient surveys indicated a statistically significant improvement in
perceived ability of nursing staff (p = .001)
 Ask Me 3 does not add time to patient visits
 Use of Ask Me 3 resulted in reduced call-backs and missed
appointments
 Over 1 million providers use the Ask Me 3 program
Ask Me 3 - For Patients
 Health information can be confusing at times
 Everyone wants help with health information
 Asking questions helps patients understand
how to prevent or manage illness
Patients Should Not Be Anxious About Asking
Their Health Care Provider Questions!
Ask Me 3 - For Providers
Health Care Providers Want Patients to Know:
 All they can about their condition/medication
 Why this advice/treatment is important for good health
 Steps to take to prevent a condition or keep it under control
Patient
Provider
Ask Me 3 – Creates Shared Responsibility
for Clear Health Communication
Patient
Provider
De-stigmatize and
Recognize
Reduce Embarrassment Patient Coping
of Low Health Literacy
Mechanisms
 Provides a consistent approach to patient-provider dialogue
 Allows patients to get information they need to manage their health
 Time-efficient for providers to reinforce healthcare instructions
What Is Ask Me 3
 Promotes three simple, but essential, questions
and answers for every healthcare interaction:
What Is My
Main Problem?
What Do I
Need to Do?
Diagnosis
Treatment
Why Is It
Important for Me
to Do This?
Context
Ask Me 3 – For Patients
 Element: Poster
 Description:
– Stimulates curiosity
about Ask Me 3
– Informs patients and staff
about the program
 Implementation (hang poster):
– In waiting areas
– In exam rooms
– On the ceiling, above
the exam table
– On a door
– In a staff break room
– Hang anywhere where providerpatient interaction takes place
– Anywhere patients might see it!
Ask Me 3 – For Patients
 Element: Patient brochure
 Description:
– Educates patients about
the Ask Me 3
– Motivates patients to ask their
healthcare provider questions
 Implementation:
– Display in waiting
rooms/registration area
– Distribute to patients upon
arrival/sign-in
– Distribute with any paperwork
– Distribute during events or
with mailings to patients
Ask Me 3 – For Providers
 Element: Provider brochure
 Description:
– Explains the scope and impact
of low health literacy
– Offers communication tips
– Emphasizes how effective
communication can positively
impact patient health outcomes
 Implementation:
– Distribute to all staff interacting
with patients through staff
meetings or mailings
– Conduct departmental in-service
training on Health Literacy and
Clear Health Communication
Ask Me 3 – For Providers
 www.AskMe3.org:
– Has everything you need to
start acting/implementing
– Materials can be downloaded/
ordered from this website
– Other health literacy tools
available on the site:
• Bibliography on health literacy
• List of literacy resources
• White paper on health literacy
• Links to other relevant websites
• Cultural competence primer
What Can You Do?
 Six steps to improving patient understanding
1. Limit the amount of information provided at each visit
2. Slow down
3. Avoid medical jargon
4. Use pictures or models to explain important concepts
5. Assure understanding with the “show-me” technique
6. Encourage patients to ask questions
What Else Can You Do?
People Have Difficulty Making Appointments
Appointment Instructions
Also see: Urgent Care (if you are too sick to wait for an appointment)
Making a medical appointment for the first time, it is straightforward: You call
555-2222 and make a appointment at XYZ Health Services just like you would
at any doctor's office.
You can request a specific clinician if you have someone in mind, or you can
explain your need or problem to the appointment counselor, and he or she will
schedule you with an appropriate clinician at the earliest possible date. At your
first appointment you will receive a medical record card -- often referred to as
your "gold card" -- which you will keep and use as your XYZ Health Services
identification.
If you are unsure about whether you should make an appointment, you may call
the Advice Nurse at 666-7777. Also, in advance of your first appointment, be
sure to read "How to Make the Most of Your XYZ Visit."
Please call 643-7177 to make an appointment in the Specialty Clinics, including
Allergy & Travel. Specialty appointments require a referral.
You may also drop by the Appointment Office to make a medical appointment.
The Appointment Office is located on the first floor in Room 1111. You may
also make an appointment in the Specialty Clinics by going to the Specialty
Clinic reception desk, located behind the elevators on the first floor.
If you need to cancel an appointment, please call our 24-hour cancellation line
at 643-7033. Please note that you will be billed for a broken appointment fee if
you do not show up for your appointment and have not called to cancel it.
 When making an
appointment, provide
people with simple options
and clear facts
Your Name
Your Appointment Date
Time
Place
Our Telephone Number:
Do not eat or drink for 6 hours
before the day and time on this card.
What Else Can You Do?
People Have Trouble Understanding Phone Recordings
 Phone answered by a tape
recording. Speaking quickly,
the caller is offered numerous
options and alternatives
 Speak slowly and clearly
 Provide an easy way to
connect with a live person
 Provide options in
other languages
What Else Can You Do?
People Have Trouble Reading Signs
Ambulatory
Entrance
Ambulatory
Entrance
Hospital XYZ
 Some people become
confused about whether
this entry was intended for
ambulances or for patients
 The use of visuals clarify
the message
 Contrast in color makes
it easy to read
 Try to be consistent when
hanging signs
What Else Can You Do?
People Have Trouble Understanding Maps
Maps are usually hard to follow:
To make maps easier to follow:




 Match the color in the map with the
Too complicated
Codes are hard to understand
Names and directions not always match
Small fonts
paint color on walls or floors
 Match the names in the map to the
names on the signs
 Use 14 point font size or larger
How Can Enhanced Communication
With Your Patients Benefit Your Practice?
 Patients who understand health care information may:
–
–
–
–
–
–
Be more compliant with instructions and medications
Call back less often
Visit less often
Have fewer hospitalizations
Have better health outcomes
Have increased patient satisfaction
Greater Provider Satisfaction
Help Patients Understand…
The Practical Solution: