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Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School of Community Health and Policy Morgan State University Verna L. Welsh, PhD, MPH Rollins School of Public Health Emory University

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Page 1: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Exploring the Business and Clinical Cases for Screening for Health

Literacy in Primary Care: A Case Study Using the NVS

Jonathan B. VanGeest, PhDSchool of Community Health

and PolicyMorgan State University

Verna L. Welsh, PhD, MPHRollins School of Public

HealthEmory University

Page 2: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Verna L. Welch, PhD, MPH, Rollins School of Public Health, Emory University (co-PI)

Gregory Strayhorn, MD, Morehouse School of Medicine, Department of Family Medicine (co-I)

Page 3: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Overview1.Define limited health literacy

2.Discuss the role of health literacy in health care, outcomes, and disparities

3.Discuss approaches to improve care for at-risk patients

4.Outline clinical intervention to improve care for patients with limited health literacy

5.Study outcomes

Page 4: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Overview1.Define limited health literacy

2.Discuss the role of health literacy in health care, outcomes, and disparities

3.Discuss approaches to improve care for at-risk patients

4.Outline clinical intervention to improve care for patients with limited health literacy

5.Study outcomes

Page 5: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Health Literacy Is…“The degree to which individuals have the capacity to obtain, process, and understand basic health infor-mation and services needed to make appropriate health decisions.”-Healthy People 2010

Ability to perform essential health care tasks:

– Understand appointment slips– Follow health instructions– Obtain information about an illness– Participate in discussions of informed consent– Enroll in health insurance plan

Page 6: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Not Simply a “Patient Problem”

• One with implications for quality shared by the provider, healthcare system, and community in partnership with the patient

• Implications for treatment as well as disease prevention/health promotion

Page 7: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Overview1.Define the scope of limited health literacy

2.Discuss the role of health literacy in health care, outcomes, and disparities

3.Discuss approaches to improve care for at-risk patients

4.Outline clinical intervention to improve care for patients with limited health literacy

5.Study outcomes

Page 8: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Health Literacy Is Needed to Navigate Health “Systems”

• Most patient instructions are written• Verbal instructions

– Often complex– Delivered rapidly– Easy to forget in stressful situation

• Increasingly complex health system– More medications– More tests and procedures– Greater self-care requirements– Participatory/informed decision-making

• Disease prevention/health promotion messages

welchv
This is another opportunity (or maybe on the next slide to get them thinking about the HL- HP/DP relationship -- I know you have a section on this but any nuggets you can give to keep their attention so they won't wonder "how/why is this relevant" would be helpful
Page 9: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes Associatedwith Health Literacy

Health Outcomes General health status Hospitalization Emergency department use Prostate cancer stage Depression Diabetes control HIV control Mammography Pap smear Pneumococcal immunization Influenza immunization STD screening Cost

Behaviors Only Substance abuse Breastfeeding Behavioral problems Adherence to medication* Smoking*

Knowledge Only Birth control knowledge Cervical cancer screening Emergency department

instructions Asthma knowledge Hypertension knowledge

DeWalt, JGIM 2004

Page 10: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Overview

1.Define the scope of limited health literacy

2.Discuss the role of health literacy in health care, outcomes, and disparities

3.Discuss approaches to improve care for at-risk patients

4.Outline clinical intervention to improve care for patients with limited health literacy

5.Study outcomes

Page 11: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Recommended Approachesfor Health Care Providers

• Use simple, everyday language• Stick to a 2-3 key points• Draw pictures, write down key instructions

for patients to take home• Effectively solicit questions:

“What questions do you have?”• Ask patients to “teach-back” the main

points to confirm understanding

Page 12: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Problems

• Most clinicians often unaware of patient’s health literacy

• Unable to tailor the clinical encounter to the needs of patients

• Often identified solely as a patient education issue

Page 13: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Patient Perspective

• Improve literacy• Patient Education• Empowerment in the clinical encounter– Ask Me 3

Page 14: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Problems

• Complexity– Health literacy in context

• Expert Authority• Universal rather than targeted approach

Page 15: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Overview

1.Define the scope of limited health literacy

2.Discuss the role of health literacy in health care, outcomes, and disparities

3.Discuss approaches to improve care for at-risk patients

4.Outline clinical intervention to improve care for patients with limited health literacy

5.Study outcomes

Page 16: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Nurses

Physicians

Health Communication

Training

Patient

AHL

LHL

Level of Health Literacy (Score)

EMR

Clinical Intervention

AHL

LHL

Patient Outcomes

Immed. Post

6 Mth. Post

Sur vey

EMR

Sur vey

EMR

Improve Care

Reduce Disparities

Page 17: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Identifying At-Risk Patients A bilingual (English and

Spanish) screening tool that identifies patients at risk for limited health literacy

Developed by Barry Weiss (University of Arizona)

Based on a nutrition label from an ice cream container

Page 18: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Process Patient is given the label Asked 6 questions about how they would

interpret and act on the information Responses are recorded by a clinical staff

member, scored, and entered into the EMR Based on the number of correct responses,

the health care provider can assess the patient’s health literacy level

Page 19: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Overview1.Define the scope of limited health literacy

2.Discuss the role of health literacy in health care, outcomes, and disparities

3.Discuss approaches to improve care for at-risk patients

4.Outline clinical intervention to improve care for patients with limited health literacy

5.Study outcomes

Page 20: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Patient Characteristics

Page 21: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Health Literacy

At-risk for LimitedHealth Literacy

Physicians were not identifying at-risk patients or using recommended communication practices

Page 22: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Patient Reaction

Patients’ Reactions to Screening Over 95% of patients did not have problems with

screening for health literacy in primary care.

No difference in the reported prevalence of shame (p<0.33) by literacy level (Fisher’s Exact Test)

Page 23: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Patient Reaction Patient Recommendations Regarding

Screening (n= 135)

Page 24: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes - Patient

Fff

Page 25: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Business Case

Page 26: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Physician Utilization

Staff training increased awareness of the importance of health literacy and clear health communication

A majority (66.7%) also felt that using the NVS to identify patients with limited health literacy improved their quality of care they were able to deliver

Page 27: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School

Outcomes – Physician Utilization

Over 60% also felt that scores helped in customizing their communication with patients

Observed tendency to revert back to their normal – pre-intervention – care processes and behaviors