Transcript Health Literacy - Cynosure Health

Health Literacy
Cynosure Health Summit
May 21, 2012
Jennifer Pearce, MPA
Heart Failure Program Coordinator & Health Literacy Consultant
Sutter Health
Wall Street Journal
December 5, 2006
PATIENT SKILLS:
College educated
Health care
experience
Prepared for medical
appointments
Had support system
SYSTEM BARRIERS:
Multiple providers
(12)
Had Medicaid, then
uninsured
Miscommunication
led to lack of followup care
Didn’t understand
options
Outline
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Definition of health literacy
Prevalence
Why it matters (quality/compliance/safety)
Readmissions
Care Transitions Team for Heart Failure plan for
addressing health literacy
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Measurement
Universal precaution approach: written
Nuanced approach: verbal
Expectations
What you can do now
How is “health literacy” different from
“literacy”?
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Literacy refers to having the basic skills to
read, write and compute without regard to
context
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Health literacy is the concept of reading,
writing, computing, communicating and
understanding in the context of health care
Source: Weiss B. Epidemiology of Low Health Literacy. Understanding Health Literacy: Implications for Medicine and
Public Health
Posted at the entrance to the ED of a Bay Area
hospital: the county’s “major source of acute care for
medically indigent and uninsured patients”
Notice for emergency services:
This Hospital must provide emergency services and care to
any individual, including women in labor, who requests
services, examination or treatment, or for whom services,
examination or treatment is requested, regardless of the
individual’s ability to pay for these services, so long as the
Hospital has appropriate facilities and qualified personnel
available.
In no event shall the provision of emergency services and care
be based upon, or affected by, the individuals race, ethnicity,
religion, national origin, citizenship, immigrant status, age,
sex, preexisting medical condition, physical or mental
handicap, insurance status, economic status, or ability to pay
for medical services, except to the extent preexisting medical
conditions or physical or mental handicap is medically
significant to the provision of appropriate medical care to the
individual.
Is this equitable access?
Notice for emergency services:
This Hospital must provide emergency
services and care to any individual,
including women in labor, who requests
services, examination or treatment, or for
whom services, examination or treatment
is requested, regardless of the individual’s
ability to pay for these services, so long as
the Hospital has appropriate facilities and
qualified personnel available.
In no event shall the provision of
emergency services and care be based
upon, or affected by, the individuals race,
ethnicity, religion, national origin,
citizenship, immigrant status, age, sex,
preexisting medical condition, physical or
mental handicap, insurance status,
economic status, or ability to pay for
medical services, except to the extent
preexisting medical conditions or physical
or mental handicap is medically significant
to the provision of appropriate medical
care to the individual.
Flesch-Kinkaid Grade Level: 12
Evolving definitions of health literacy
A person’s ability to obtain, process
and understand basic health
information and services needed to
make appropriate health decisions
Prose literacy: texts
 Document literacy: appointment slips
 Quantitative literacy: nutrition labels
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Sources: IOM. 2004. Health Literacy: A Prescription to End Confusion
Evolving definitions of health literacy:
Dual nature of communication in health literacy
Health system’s demand
and complexity
Health
Literacy
Patient’s skill
and ability
Source: Parker, R. and Ratzan, S. 2010. “Health Literacy: A Second Decade of Distinction for Americans',
Journal of Health Communication” 15: S2, 20 — 33
Lack of concordance
Most health materials are written at a level that
exceeds the reading skills of the average high school
graduate.
Source: Rudd, R. 2010. “Literacy and Health.” Harvard School of Public Health
Health system’s
demand and
complexity
Health
Literacy
Patient’s skill
and ability
Prevalence: 9 out of 10 adults lack the
skills needed to manage their health
2003 National Assessment of Adult Literacy
Below Basic
14%
Proficient
12%
Basic
22%
Intermediate
52%
2003
National
Assessment
of Adult
Literacy
Source: U.S. Department of
Education, Institute of
Education Sciences, 2003
National Assessment of Adult
Literacy
Adult health literacy by highest level of
education
Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy
Adult health literacy by age
Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy
Being able to understand matters to
patients
Low health literacy associated with:
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Adverse health outcomes
Increased risk of hospitalization
Increased mortality rates
Increased cost to U.S. economy: estimates vary but all are in the
billions; due to increased utilization
Why? Individuals with low health literacy are more likely to:
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skip necessary medical tests
use the emergency room more often
have a harder time managing chronic diseases like diabetes or high
blood pressure
Source: IOM Report on Health Literacy: A Prescription to End Confusion
Source: Baker et al. AJPH. 2002. 92:1278
Source: JAMA, April 27, 2011 – Vol. 305, No. 16
Source: Low Health Literacy: Implications for National Health Policy. University of Connecticut, 2007
Source: Rudd, R . E., et al (2007). Health literacy: An update of public health and medical literature. In J. P. Comings, B.
Garner, & C. Smith. (E ds.), Review of adult learning and literacy (vol . 7) (pp 175–204).
Health literacy matters to CMS
Quality
 HCAHPS
survey:
Health literacy matters to HHS
Compliance
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Affordable Care Act established statutory definition of
health literacy
Plain language requirement for health insurers
Health literacy matters to the
Joint Commission
Safety
The
Joint Commission: “Effective
communication is a cornerstone of patient
safety.”
Sentinel
event database: 65% of identified
adverse events have communication failures
as the underlying root cause
Source: The Joint Commission (2007)“What Did the Doctor Say?:” Improving Health Literacy to Protect
Patient Safety
Care Transitions Team for Heart Failure:
Our reality
At least 54% of our heart failure patients may have
limited health literacy
Source: AHRQ Limited Health Literacy Prevalence Calculator
Literature strongly supports considering health
literacy as part of a plan to reduce heart failure
readmissions
Care Transitions Team for Heart Failure:
Program Design
Hospital
Heart Failure
admission
assess readmission
risk
Assess health
literacy during
inpatient stay
Telemanagement at home
•medication reconciliation
24-48
hrs.
•education
•care transitions assistance
60 – 90 days on service
Score determines
pace of teaching
post-discharge
Our plan: Universal precaution approach
Take a universal precaution approach in our
written material and a nuanced approach
in our verbal communication
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Measure: Newest Vital Sign tool
Distribute: tested and clearly
written/illustrated material that corresponds
with education goals
Pace and prioritize: teaching according to
patient motivation and capability
Offer additional resources on demand
Measure: Newest Vital Sign
health literacy assessment
ICE CREAM
Distribute one set of materials for all literacy
levels: Heart Failure Discharge Tool
Distribute one set of materials for all
literacy levels: Self-care booklet
Self-care booklet divided
into:
 What is heart failure?
 My medications
 My diet
 My exercise plan
 My daily check-up
Interventions that build selfcare skills can overcome
health literacy related health
disparities
Source: Pignone, M. 2008. Literacy and Adherence.
http://nchealthliteracy.org/teachingaids.html
Pace and prioritize: Teaching
Printed materials + oral interaction = most effective results
Health literacy score provides and idea of
where patient is starting from
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What sort of “cognitive Velcro” is already present?
Should information be presented in smaller chunks?
What vocabulary and concept load are appropriate?
Score should be taken in context
(Example: Older adults, regardless of socioeconomic status, have
higher rate of limited health literacy; struggle with “mental
multitasking” and “fluid intelligence”)
Source: Schwartzberg, J. 2005. Understanding Health Literacy: Implications for Medicine and Public Health and
Speros, C. 2011. http://www.healthliteracyoutloud.com/2010/12/14/health-literacy-out-loud-50-communicatingabout-health-with-older-adults/
Offer additional resources on demand
Video, print, or interactive - depending on the
patient’s learning style
Expectations
We expect to conduct up to 500 inpatient
health literacy assessments by end of 2013
By proactively addressing health literacy:
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Gain greater insight into readmission risk
Offer more complete picture to outpatient providers
Enhance care experience for heart failure patients
 Disease management
 Health system navigation
 Self-advocacy
Reduce readmissions
Knowing this, what can you do now?
1.
Assess
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2.
Ask
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3.
Language, font, white space, organization, graphics
Test
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5.
What do your patients do with the materials when the
get home?
What information do patients wish they had?
What questions are staff getting?
Revise
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4.
How accessible are your current patient education
materials?
Why are you giving them out?
Patients are your partners
Refine
Questions?
Jennifer Pearce, MPA
[email protected]