Putting Health Literacy into Practice. IHC Care Coordination Conference June 3, 2015

Transcription

1 Putting Health Literacy into Practice IHC Care Coordination Conference June 3, 2015

2 Objectives Review the essentials of health literacy. Detail how health literacy can improve existing patient engagement strategies. Introduce valuable health literacy resources. Overview promising practices in addressing health literacy.

3 Essentials Definition: The ability to obtain, process, and understand basic health information and services to make appropriate health decisions.

4 Essentials Support for Health Literacy Efforts Affordable Care Act (ACA) National Action Plan to Improve Health Literacy Plain Writing Act of 2010

5 What is literacy? The Ability to read and write What is health literacy? Essentials Social and individual factors Reading and writing skills Listening and speaking Numerical and mathematical knowledge Conceptual knowledge

6 Essentials Health Literacy expands beyond basic literacy to identify comprehension capacity Health literacy is one of the strongest indicators of an individual s health status Greater than age, race/ethnicity Education level Employment and health coverage status.

7 Essentials

8 Essentials Key Contributors Education Culture Language Communication and assessment skills Social determinants of health

9 Essentials Health literacy is a dynamic relationship between skills and ability & demands and expectations.

10 Health Literacy Framework

11 Health Literacy Framework

12 Who is at risk? Essentials Those who are not familiar with medical terms or how their bodies work. Those who have been diagnosed with a serious condition (scared and shocked). Those who have health conditions that require complicated self care. They have to interpret or calculate numbers or risks that could have immediate effects on their health and safety.

13 Essentials Greatest Risk Factors Limited English proficiency Older and elderly patients Limited education level

14 Essentials 90 million limited health literacy unable to fully utilize the health care system as it is 45% able to complete simple and routine tasks using uncomplicated materials 55% able to locate information in moderately complex text, make inferences, and integrate information IOM. Health Literacy: A prescription to end confusion. 2004

15 Essentials Only 12% of U.S. adults have the health literacy proficiency to perform complex health tasks Kutner, et al. (2006). The Health Literacy of America s Adults: Results From the 2003 National Assessment of Adult Literacy.

16 Essentials Efforts to improve quality, reduce costs, and reduce disparities cannot succeed without advancements in health literacy Health literacy must be a vital, collaborative effort from public health, health systems, education system, and society overall A health literate society could save excess health care costs estimated at over $106 billion $239 billion annually

17 Essentials Poor Health Literacy leads to poor health outcomes Lower reported health status Greater mortality Less disease specific knowledge and ability to recognize common signs and symptoms of illness Greater utilization of hospital services Less self confidence and skills needed for self care and chronic disease management Lower receipt of important screening procedures and vaccinations Poorer understanding of medication and food labels

18 Essentials Low health literacy spans across populations Never assume one s health literacy level Higher education does not necessitate high health literacy Stress is a confounding factor for consideration Principles of health literacy should be applied to all patients!

19 Integrating Health Literacy Plain language Intentional conversations, i.e. Teach back Assessment Tools Readability reviews Develop health literacy/educational strategic plan Patient surveys (ex: CAPHS)

20 Integrating Health Literacy

21 Integrating Health Literacy Plain Language Avoid medical jargon Use common, everyday words Use small, concise statements Use active voice Use identifying pronouns You

22 Integrating Health Literacy Teach back Teach back is an easy to use, coaching tool to assist in assuring patient understanding Asks patients to repeat the health information given them in their own words Check for understanding Avoid one word responses Ask patients to demonstrate when appropriate

23 Integrating Health Literacy Teach back is effective in a variety of settings Discharge and transitions of care Primary Care office Health education Presents opportunity to identify potential gaps in understanding prior to patient leaving care setting

24 Integrating Health Literacy Considerations to Keep in Mind Use plain language Complete the interactive communication loop Seek the patient s perspective Check for understanding Provide clarifications Re check for understanding

25 Ask Me 3 Integrating Health Literacy Patient education program developed by the National Patient Safety Foundation Encourages patient led discussions through asking of three questions: 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

26 Integrating Health Literacy Choosing Wisely National initiative to promote informed conversations between patients and providers Focus on avoidance of unnecessary medical tests, procedures, and treatments Lead by the ABIM Foundation, RWJ Foundation, and Consumer Reports 70+ special society partners

27 Integrating Health Literacy Choosing Wisely 5 Questions to Ask to Ask Your Doctor

28 Assessment Tools TOFHLA REALM SAHLSA SAHL S& E Newest Vital Sign

29 Assessment Tools Short Assessment of Health Literacy (SAHL) Spanish & English (S & E) First dual language assessment tool 18 item word association assessment Fully validated and tested, including language considerations Consistent with REALM & SAHSLA format, endorsed by AHRQ

30 Assessment Tools

31 Assessment Tools SAHL S & E Pilot Project Purpose to evaluate SAHL assessment tool in practice Focus on efficacy of the tool in use Testing site Dallas County Public Health Nursing Services (DCPHNS), Dallas County, IOWA

32 Assessment Tools Tool was disseminated among DCPHNS staff focus on those who provide direct patient care or services. Staff were educated on the purpose of the pilot and instructed in the administration of the tool and scoring process 14 out of 18 considered low health literacy

33 Assessment Tools To assess efficacy of the tool, staff asked to complete a review following each assessment Questions based upon diffusion of innovation theory 5 questions in total, based on 5 point Likert scale response

34 Assessment Tools

35 Assessment Tools Pilot Results 36 assessments completed: 22 patient/client, 16 staff based 18 English, 4 Spanish Average health literacy score: Patient/client: 16 Staff: 18 important to note, not all were high scoring

36 Assessment Tools # of Assessments Health Literacy Assessment Scores, Patients and Clients Asessment Scores 1 1 English Spanish

37 Assessment Tools Pilot Results Tool rated as Easy or Very Easy to perform All respondents indicated health literacy as Essential or as a High Priority Indications for fit of tool or process in existing workflow varied; significant range among Excellent, Very Good, and Poor.

38 Pilot Results Assessment Tools Effect of tool in interventions following assessment, was divided between reports of Major Effect and Minor Effect or No Effect. Participant reports regarding likelihood of full integration of the SAHL S&E tool was similarly divided on the spectrum between the Likely and Unlikely.

39 Assessment Tools

40 Assessment Tools

41 Assessment Tools

42 Assessment Tools Conclusions and Next Steps Average health literacy scores vary from expectation Tool appears to be easy to use and incorporate, need to further determine variance in interventional impact and implementation DCPHNS to expand evaluation and build specific protocols for use

43 What Can You Do? Where to start? Develop an Organizational Plan Identify champions and get buy in Commit and Assess Spread awareness Create a strategic plan for health literacy Make health literacy part of your organizational culture.

44 Resources Institute of Medicine, Health Literacy: A Prescription to End Confusion National Assessment of Adult Literacy (2003) National Action Plan to Improve Health Literacy Consumer Assessment of Healthcare Providers and Systems (CAHPS) Questionnaire PlainLanguage.gov.

45 Resources AHRQ, Universal Precautions Toolkit Centers for Disease Control and Prevention Institute for Healthcare Advancement Institute for Healthcare Improvement Iowa Department of Public Health Iowa Healthcare Collaborative

46 Thank You! Kady Hodges, MPH Clinical Strategies Coordinator Iowa Healthcare Collaborative Shelley Horak, MPH, CPM Executive Director Dallas County Public Health Nursing Services