health literacy & health literate care presented by jennifer pearce, mpa health literacy program...
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Health Literacy & Health Literate Care
Presented by Jennifer Pearce, MPAHealth Literacy Program Manager
Sutter Center for Integrated Care, Sutter Health
September 12, 2014
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Presentation Objectives
• Define health literacy and understand prevalence of low health literacy among adults
• Understand relationship between health literacy and patient engagement
• Identify interventions to reduce health system demand/complexity and increase patient skills/ability
My Story
Wall Street Journal December 5, 2006
College educated
Health care experience
Prepared for medical appointments
Had support system
PATIENT SKILLS:
Multiple providers (12)
Had Medicaid, then uninsured
Miscommunication led to lack of follow-up care
Didn‘t understand options
SYSTEM BARRIERS:
Nikki didn’t die from lupus, Nikki died of complications of the failing health care system.- Dr. Amylyn Crawford PBS Frontline, Sick Around America
How Is “Health Literacy” Different From “Literacy”?
• Having the basic skills to read, write and compute without regard to context
Literacy
• Reading, writing, computing, communicating and understanding in the context of health care
Health literac
ySource: Weiss B. Epidemiology of Low Health Literacy. Understanding Health Literacy: Implications for Medicine and
Public Health5
Health Literacy Includes One’s Ability To Perform Multiple
Tasks
Healt
h
litera
cyObtain Document
literacy
Process Prose literacy
Understand Quantitative literacy
Communicate: listen and
speak
Numeric literacy
Source: IOM. 2004. Health Literacy: A Prescription to End ConfusionSource: Schwartzberg, J. 2005. Understanding Health Literacy: Implications for Medicine and Public Health
6
Mismatch Leads to Harm
Source: Parker, R. and Ratzan, S. 2010. “Health Literacy: A Second Decade of Distinction for Americans', Journal of Health Communication” 15: S2, 20 — 33
Health literac
yPatient
skills/ability
Health system demand/
complexity
Patient Skills: Prevalence Of Low Health
Literacy2003 National Assessment of Adult Literacy
Proficient12%
Below Basic14%
Intermediate52%
Basic22%
8Source: 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
Only 1/3 of those with a graduate degree have the skills to effectively manage a chronic illness
9
Adult health literacy by
age
Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy
Only 3% of those age 65+ have the skills to effectively manage a chronic illness
10
NAAL (2003)
Program for the International Assessment of Adult Competencies (PIAAC) 2012
“Using digital technology, communication tools, and networks to acquire and evaluate information, communicate with others, and perform practical tasks.”
Is This Equitable Access?
• Find a doctor and define the preferred relationship
• Articulate health issues
• Share, access, and evaluate information
• Negotiate decisions
• Develop partnership with the patient
• Identify/review patient preferences and patient’s preferred role
• Identify choices
• Present evidence and help patient reflect
Health literate tools + training promote shared decision making
Improved satisfaction, better outcomes
13
Provider competenciesPatient competencies
Source: E. Bernabeo and E. Holmboe (2013). Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Affairs 32, No. 2: 250-258
• 5 of 35 recent grads said they received no training on health literacy during medical school.
• Dr. Cliff Coleman et al, 2013 Journal of Health Communication Consensus Study - “curricula needed to produce a health care
workforce which is not only aware of the issues around low health literacy, but is
also prepared to address them.” Echoed by 2010 National Action Plan to Improve Health Literacy – workforce objectives.
Is our health care workforce prepared to engage patients?
Journal of Health Communication, 18:82-102,2013.
Examples of Health Literacy CompetenciesKnowledge
• Knows that educational attainment is an inadequate marker for health literacy skills.
• Knows that the average US adult reads at an 8th-9th grade level.
• Knows that patients learn best when a limited number of new concepts are presented at any given time.
Journal of Health Communication, 18:82-102,2013.
Examples of Health Literacy Competencies
Skills
• Demonstates ability to recognize, avoid and/or constructively correct the use of medical jargon.
• Demonstrates ability to recognize plain language principles in written materials.
• Demonstrates effective use of teach back technique for assessing patient understanding.
Journal of Health Communication, 18:82-102,2013.
Examples of Health Literacy Competencies
Attitudes
• Expresses the attitude that effective communication is essential to the delivery of safe, high quality health care.
• Expresses the attitude that it is a responsibility of the health care sector to address the mismatch between patients’ and health care providers’ communication skills.
Journal of Health Communication, 18:82-102,2013.
How do you do it?
Aware Prepare
Health Literate Care Delivery
Single Item Health Literacy Screener
“How confident are you at filling out medical forms by yourself?”
1. Extremely2. Quite a bit3. Somewhat (cut point)4. A little bit5. Not at all
Source: Stagliano V, Wallace LS. Brief health literacy screening items predict newest vital sign scores. J Am Board Fam Med 2013;26(5):558-565.
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Distinct health literacy tasks Potential navigation pitfalls15
Source: DeWalt, D. A., and J. McNeill. 2013. Integrating health literacy with health care performance measurement. Discussion Paper, Institute of Medicine, Washington, DC. http://www.iom.edu/linktoyourpaper.
Reading abilityEducation
level
Socio-economic status
Universal Precaution Approach
Best Practice – Universal Precaution Approach to Health
Literacy
Source: Smith, Sandra A. (2001). Patient Education and Literacy in Labus, A. & Lauber, A. (Eds.) Preventive Medicine and Patient Education. Philadelphia: WB Saunders, 266-290. 21
Evidence: Easy-to-read is Preferred!
College educated readers’ response to health information written at 5th grade level:
Recall of key messages
Satisfaction
Source: Smith SA. Information giving: Effects on birth outcomes and patient satisfaction. Int Electronic J Health Educ 1998:;3:135-145.
22
System Resources
One Patient – One Message Disease and condition management (stoplights)Personal health record (electronic & paper)High risk medication tools
Acute Ambulatory
Skilled &Rehab
Home care,
Palliative & Hospice
23
Stoplight tools Condition specific
Symptom management
Medication management
• Heart failure x
• COPD x
• Falls x
• Wounds x
• Pneumonia x
• Depression x
• Nausea x
• Constipation x
• Pain x
• Anxiety x
• Diabetes x
• Stroke x
• Shortness of breath x
• Bleeding x
• Coumadin x
• Tamoxifen x
• Lovenox et al x
• Plavix et al x
• Methotrexate x
• Swallowing/Aspiration x
• Weight gain/Edema x
• Skin/Pressure ulcer x
Health literate
personal health record
(PHR)
Where will you hitch your health literacy wagon?
Health Literate Care Promotes IOM Aims
Patient
Timely
Safe
Equitable
Patient centered
Efficient
Effective
Health Literate Care Resources
http://www.health.gov/communication/interactiveHLCM/#resources
When a health care organization adopts the Health Literate Care Model, health literacy becomes an organizational value infused into all aspects of planning and operations.
Health Aff February 2013 vol. 32 no. 2 357-367
We can no longer afford this …
28
Jennifer Pearce, MPAHealth Literacy Program ManagerSutter Center for Integrated CareSutter Health
Contact: pearcej1@sutterhealth.orgwww.suttercenterforintegratedcare.org
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