Form #5 Form #5 Webinar/Orientation Presentation

Demonstration of Health Literacy Universal Precautions Toolkit

Practice Orientation Webinar

HOUSEKEEPING:  Would like to have them complete evaluation forms at the end.

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Webinar Agenda

• Introduction to health literacy 

• Introduction to the Health Literacy Universal Precautions Toolkit 

• Introduction to the Demonstration 

• Data Collection Procedures 

• Implementation Timeline 

 

Introduction to Health Literacy

 

What is health literacy?

The capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

HL is believed to be composed of a variety of components.

Most work has focused on reading ability and to a lesser extent numeracy – that’s what we’ll focus on today.

Institute of Medicine (IOM) Committee on Health Literacy. (2004). Health Literacy: A Prescription to End Confusion.

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Prevalence and Implications

• National Assessment of Adult Literacy – 2003 

• • oFirst national assessment of health literacy 

• 35% had basic or below basic skills (77 million U.S. adults) 

  • oFollowing directions on a medication bottle 

  • oAdhering to a childhood immunization schedule using a chart 

• Prevalence of limitations (basic or below) vary by: 

  • oEducation: 76% who did not complete HS; 44% of HS grads 

  • oRace/ethnicity:  28% non-Hispanic Whites; 65% of Latinos 

  • oAge:  31-35% before age 65; 51% of adults aged 65-75 

• Limited health literacy related to poor knowledge, increased hospitalizations/ER use, more limited use of preventive care, poor comprehension of meds and health information, mortality 

• Providers can help to restore the balance between patient skills and information complexity 

Adults aged 16+

National Center for Education Statistics – Kutner et al 2007 – 2003 NAAL general results – data collected in 2003 and 2004 – randomly selected households

Examples of Document: application form

Some skills tested are health related and others focus on other math skill encountered in everyday life

HL results:  

4 levels – proficient, intermediate, basic, below basic

Lowest 2 levels considered inadequate; they cannot:

Following directions on a medication bottle

Adhering to a childhood immunization schedule using a standard chart

12% college grads

57% of African Americans; 70% of adults >75

Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy.

14% Below Basic

21 % Basic

53% Intermediate

12% Proficient

HL correlates from AHRQ 2011 report

Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites.

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Introduction to the Toolkit

 

Toolkit Development

• Developed by the North Carolina Network Consortium and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill 

• With support from the Agency for Health Care Research and Quality 

• Objective:  Provide primary care practices with step-by-step guidance for assessing a practice’s health literacy environment and making changes to lessen the health literacy burden for patients 

• Multi-step approach to development 

 

Toolkit Contents

• 20 tools focusing on four domains related to health literacy 

• • oTools to Start of the Path to Improvement 

  • oDomain 1:  Tools to Improve Spoken Communication 

  • oDomain 2:  Tools to Improve Written Communication 

  • oDomain 3:  Tools to Improve Self-Management and Empowerment 

  • oDomain 4:  Tools to Improve Supportive Systems 

• Tools contain: 

  • oOverview and purpose 

  • oAction items and tips 

  • oTracking progress 

  • oResources 

 

Required Tools

• Two tools are required for all practices 

• Getting prepared for Toolkit implementation 

• Required tools 

• • oTool 1: Form a Team  

  • oTool 2: Assess Your Practice  

 

Supplementary Tools

• All practices will select two supplementary tools 

• Supplementary tools 

• • oTool 3: Raise Awareness  

  • oTool 4: Tips for Communicating Clearly  

  • oTool 5: The Teach-Back Method  

  • oTool 8: Brown Bag Medication Review 

  • oTool 11: Design Easy-to-Read Material 

  • oTool 12: Use Health Education Material Effectively  

  • oTool 13: Welcome Patients: Helpful Attitude, Signs, and More 

  • oTool 14: Encourage Questions 

  • oTool 16: Improve Medication Adherence and Accuracy 

  • oTool 20: Use Health and Literacy Resources in the Community 

 

Optional Tools

• The Toolkit contains several tools that are not a primary focus of the project 

• Practices may choose to implement one or more of these tools  

• • oThese tools do not count among the practice’s two supplementary tools 

• Optional tools 

  • oTool 6: Follow Up with Patients 

  • oTool 7: Telephone Considerations 

  • oTool 9: How to Address Language Differences 

  • oTool 10: Culture and Other Considerations 

  • oTool 15: Make Action Plans 

  • oTool 17: Get Patient Feedback 

  • oTool 18: Link Patients to Non-Medical Support 

  • oTool 19: Medication Resources 

 

The Demonstration

 

The Demonstration

• University of Colorado and American Academy of Family Physicians 

• • oWith support of AHRQ 

• Objectives 

• 1. 1.Examine the utility of the Toolkit for primary care practices seeking to improve their health literacy-related systems and processes, and 

  2. 2.Identify possible refinements that would enhance the Toolkit as a resource for primary care practices. 

• Procedures 

• • oImplement Toolkit in 12 diverse primary care practices 

• • • •6-8 month implementation period 

    • •Practices implement Tools 1 and 2 as well as two supplementary tools 

  • oCollect data about health literacy-related systems and procedures (pre-post) 

  • oCollect data about experience of using the Toolkit and suggested improvements 

  • oTechnical assistance 

 

Project Activities and Timeline

• Month 1 

• • oCollection of pre-implementation data 

  • oPre-implementation site visits 

• • • •Interviews and observation 

  • oBegin implementation of Tools 1 and 2 

• Months 2-7:  Implementation of two supplementary tools 

• Month 8 

  • oCollection of post-implementation data  

  • oPost-implementation site visits 

    • •Interviews and observation 

 

Data Collection Activities

• Tool 2 Health Literacy Assessment Questions (pre-post) 

• Patient Survey (pre-post) 

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) (pre-post, 2 practices) 

• Practice Staff Survey (pre-post) 

• Health Literacy Team Leader Survey (pre-post) 

• Implementation Tracking Form (pre-post and before technical assistance calls) 

• Medication Review Form (pre-post, Tool 8 practices only) 

 

Site Visits and Technical Assistance

• Site Visits 

• • oInterview with Health Literacy Team Leader (pre-post) 

  • oInterview with Health Literacy Team Member (post) 

  • oInterview with 1-2 staff members (post) 

• Technical Assistance 

  • oRoutine calls 2 weeks, 1 month, 2 months, and 4 months into implementation 

  • oAvailable for questions any time 

 

Resources

• David West, Principal Investigator 

• • o[email protected], 303-724-1170 

• Angela Brega, Task Order Leader 

  • o[email protected], 303-724-1470 

• Liz Horsley, Project Manager 

  • o[email protected], 800-274-2237 x3173