A
Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
Survey (Post-Implementation)
Demonstration of Health Literacy Universal Precautions Toolkit
Date:
Instructions:
As part of its participation in the Health Literacy Project, your practice will work to improve patient care by implementing the Health Literacy Universal Precautions Toolkit. To help us see whether using the Toolkit results in changes in clinical and other practices, we ask that the leader of the practice’s Health Literacy Team complete this Health Literacy Team Leader Survey at the beginning and the end of the project.
Questions about the Health Literacy Team
Who are the members of your Health Literacy Team? Please identify the number of members in each of the following positions:
Physician (non-resident)
Physician (resident)
Physician assistant
_______ Nurse practitioner
Registered nurse
Other nursing staff (LPN, CPN)
Medical assistant
Practice manager/office manager
Office staff (front desk; business office; medical records)
Social worker/Counselor/Behavioral health worker
Pharmacist
Dietitian
Patient or Patient Caregiver
Other (please specify: )
Public reporting burden for this collection of information is estimated to average 20 minutes per response, the estimated time required to participate in this survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.
How often do Health Literacy Team meetings generally take place?
More than once a week
Weekly
Every two or three weeks
Monthly
Every other month
Quarterly
Less than quarterly
How long do meetings usually last?
Less than 30 minutes
30 to 60 minutes
More than 60 minutes
At a typical meeting, how many team members are usually present?
Health Literacy Training
Since beginning the Health Literacy Project, how many training sessions have been offered to increase clinician and staff awareness of and sensitivity to health literacy issues?
(If none, please enter 0.)
5a. Approximately when did the first training session take place?
5b. Approximately when did the last training session take place?
What types of staff were invited to attend the training sessions?
Physician (non-resident)
Physician (resident)
Physician assistant
Nurse practitioner
Registered nurse
Other nursing staff (RN, LPN, CPN)
Medical assistants
Practice manager/office manager
Office staff (front desk; business office; medical records)
Social worker/Counselor/Behavioral health worker
Pharmacist
Dietitian
Other (please specify: _______________________________________________________)
6a. What percentage of each type of staff attended at least one training session?
__________ % Physician (non-resident)
__________ % Physician (resident)
__________ % Physician assistant
__________ % Nurse practitioner
__________ % Registered nurse
__________ % Other nursing staff (RN, LPN, CPN)
__________ % Medical assistants
__________ % Practice manager/office manager
__________ % Office staff (front desk; business office; medical records)
__________ % Social worker/Counselor/Behavioral health worker
__________ % Pharmacist
__________ % Dietitian
__________ % Other (please specify: ______________________________________________)
What topics did the training sessions cover? (You may have covered more than one topic in a given training session. Please mark all that apply.)
The meaning and implications of health
literacy
Strategies for clear
verbal communication with patients (e.g., speaking slowly)
How to confirm patient comprehension of medical information
(e.g., using the Teach-Back Method)
How to communicate effectively with patients by phone
How to encourage patient questions
How to design easy-to-read written materials
How to use patient education materials in
conjunction with spoken instruction
How to conduct brown bag medication reviews to enhance patient
understanding and adherence
How
to make your office welcoming and easy for patients to navigate
How to work with patients to set up systems for remembering to take
medications as directed
How to link patients to health-related and literacy resources in community (e.g., smoking cessation programs, weight management, English as a second language, reading and math classes)
Other (please specify: )
Were these training sessions conducted prior to implementing your chosen tools?
Yes
No
Were refresher training sessions conducted after beginning implementation of your chosen tools?
Yes
No
Tips for Communicating Clearly
If your practice did not use Tool 4 (“Tips for Communicating Clearly”), please go to question 12.
As part of implementing Tool 4, your practice might have asked staff and patients to assess how well clinicians and other staff communicate with the practice’s patients. We ask some questions about this process below. When you submit your completed survey to the project team, please provide copies of all Communication Self-Assessment forms completed by clinicians and staff as well as copies of any evaluation data collected from patients. Please send data collected both before and after implementation.
Did any clinicians and/or other staff members complete the Communication Self-Assessment form?
Yes
No go to question 11
10a. Approximately what percentage of the practice’s employees completed the Communication Self-Assessment form?
Before implementation: %
Don’t Know
After
implementation: %
Don’t Know
10b. Did you see improvement in how clinicians and/or other staff members rated their communication skills after implementing Tool 4?
Yes
No
Don’t Know
Did your practice have patients rate the clarity with which clinicians and other staff communicate?
Yes
No go to question 12
11a. Did patients evaluate communication both before and after implementation of Tool 4?
Yes
No go to question 12
11b. Did you see improvement in how patients rated the communication skills of clinicians and other staff after implementing Tool 4?
Yes
No
Don’t Know
The Teach-Back Method
If your practice did not use Tool 5 (“The Teach-Back Method”), please go to question 15.
When implementing Tool 5, did clinicians and/or staff complete the Teach-Back Self-Evaluation and Tracking Log?
Yes
No go to question 13
12a. Approximately what percentage of the practice’s employees completed the Teach-Back Self-Evaluation and Tracking Log:
%
Don’t Know
Did clinicians and/or other staff feel that patient comprehension improved as a result of using the teach-back method?
Yes
No
Don’t Know
Did clinicians and/or other staff obtain patient feedback on the teach-back interaction?
Yes
No go to question 15
Don’t Know go to question 15
14a. If yes, did patients feel that the teach-back method improved their understanding of health-related information?
Yes
No
Don’t Know
Brown-Bag Medication Review
For how many medication reviews did your practice bill in the past month (ICD-9 = V58.69)? If you do not know the answer to this question, please check with your billing manager.
(If none, please enter 0.)
Which of the following strategies does your practice use to help facilitate the review of patient medications? (Please mark all that apply.)
During a visit, asking patients to bring medications to a future appointment
Providing patients with a sack in which to carry medications
Reminding patients to bring medications when making appointment reminder calls
Reminding patients to bring medications on an appointment or reminder card
Placing medication reconciliation forms in patient charts
Other (please specify: )
Patient Education Materials
Does your practice have a central location where patient education materials are stored (e.g., written materials, videos, models)?
Yes
No
Don’t Know
Does your practice have a staff person who manages all patient education materials (e.g., keeps them organized, keeps materials updated)?
Yes
No
What sorts of patient education materials are available?
Written materials
Videos, DVDs or other audio/visual resources
Models
Other (please specify: )
How often does your practice update its patient education materials?
Monthly
Quarterly
Twice a year
Once a year
Less than once a year
Don’t know
Have all clinicians and other staff members who interact with patients been informed about what patient education materials are available?
Yes
No
Don’t Know
How many clinicians and staff members have received training on how to use patient education materials in conjunction with spoken instruction?
(If none, please enter 0.)
Don’t Know
Has your practice evaluated the reading level of its patient education materials?
Yes
No
Has your practice had patients review and provide feedback on its patient education materials?
Yes
No
Improving Medication Adherence
Does your practice have a system for setting up reminder aids for patients who have trouble understanding how or remembering to take their medications (e.g., pill boxes, pill cards)?
Yes
No
Don’t Know
Health and Literacy Resources
Does your practice refer patients to health-related programs, such as support groups or health education/management classes (e.g., weight management, diabetes education, exercise/fitness, stress management, smoking cessation)?
Yes
No go to question 34
Don’t Know
Does your practice maintain a list of health-related resources in the community (e.g., weight management/exercise programs; stress management; diabetes education; support groups)?
Yes
No go to question 34
Don’t Know go to question 34
How often is that list updated?
Monthly
Quarterly
Twice a year
Once a year
Less than once a year
Don’t know
What types of services are provided by the organizations on the list? (Please mark all that apply.)
Weight management programs
Fitness/exercise programs
Stress management programs
Diabetes education classes
Healthy cooking/eating classes
Smoking cessation programs
Drug/alcohol abuse programs
Support groups
Other (please specify: )
Does your practice have a referral form that is used to refer patients to health-related resources in the community?
Yes
No
In the past month, how many patients have been referred to one of these resources?
(If none, please enter 0.)
Don’t Know
Is there a place in the written or electronic health record where a referral to a health-related resource in the community can be documented?
Yes
No
Is there a place in a patient’s written or electronic health record where the results of such a referral can be documented?
Yes
No
Does your practice refer patients to education and literacy programs, such as adult education classes, general equivalency degree (GED) programs, reading or math classes, or English classes for non-English speakers?
Yes
No You are done with this survey. Thank you for your time!
Don’t Know
Does your practice maintain a list of education and literacy resources available in the community (e.g., adult education programs; general equivalency degree [GED] programs; educational programs related to math, reading, English as a second language)?
Yes
No You are done with this survey. Thank you for your time!
Don’t Know You are done with this survey. Thank you for your time!
How often is that list updated?
Monthly
Quarterly
Twice a year
Once a year
Less than once a year
Don’t know
What types of services are provided by the organizations on the list? (Please mark all that apply.)
General equivalency degree (GED) programs for those who have not completed high school
Educational programs related to math and/or reading
English as a second language classes
Other (please specify: )
Does your practice have a referral form that is used to refer patients to education or literacy resources in the community?
Yes
No
In the past month, how many patients have been referred to one of these resources?
(If none, please enter 0.)
Don’t Know
Is there a place in the written or electronic health record where a referral to an education or literacy resource in the community can be documented?
Yes
No
Is there a place in a patient’s written or electronic health record where the results of such a referral can be documented?
Yes
No
Thank you for taking the time to complete this survey!
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Demonstration of Health Literacy Universal Precautions Toolkit
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Health Literacy Universal Precautions Toolkit: Practice Staff |
| Author | Ameers |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |