ACES 2015: Welcome to Pittsburgh! UPMC Patient Experience Team Connie Feiler, Senior Manager Sarah Kastelic, Communications Specialist Think Twice about.

ACES 2015: Welcome to Pittsburgh!

UPMC Patient Experience TeamConnie Feiler, Senior Manager Sarah Kastelic, Communications Specialist

Think Twice about Health Literacy: Writing and Editing for a Patient Audience

2

Our Record of Success

• UPMC named to 2014 U.S. News & World Report Honor Roll as one of “America’s Best Hospitals” for the 15th time.

• Ranked among the top 10 in the nation in six specialty areas.

• Ranked No. 1 in Pennsylvania and the Pittsburgh Metro Area.

3

Our Past, Our Present, and Our Future

4

Participants will be able to:

•Define health literacy.

•Identify strategies to enhance health literacy.

•Create patient friendly written materials.

Our Session Objectives

5

The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

(Ratzan and Parker, 2000)

Parker, R. (2000). Health literacy: A challenge for American patients and their health care providers. Health Promotion International, 15(4), 277-283.

Excellent reference:

http://www.cdc.gov/healthliteracy/

Health Literacy

6

How is “Literacy” different than “Health Literacy”? (Source: Maureen Dowd, syndicated columnist NY Times, Pittsburgh Post Gazette, March 16, 2015)

7

What does this say?

8

93 Million Adults have Basic or Below Basic Health Literacy

9

Health Literacy

10

What do we know from a decade of research?• Low health literacy leads to:

– Lower health knowledge: less healthy behaviors.– Under-utilization of preventive services.– Poorer health outcomes.– Needless patient suffering.– Greater health costs (repeat hospitalizations; over-

utilization of health services).• Specific communication techniques may enhance health

literacy.

AHRQ, 2004; IOM, 2004; Schwartzberg, 2005

One method to determine a patient’s health literacy level is by asking the following question: •How often do you need to have someone help you when you read instructions, pamphlets or other written material from your doctor or pharmacy?*

Patients responding they need help sometimes, often or always indicate a Low Health Literacy (LHL) level. •Document “literacy” as a barrier to learning on the admission assessment under Education/Learning Needs. •Adapt your teaching strategies by using simple language and use Teach Back to check for understanding.Morris and el., 2006. The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability; BMC Family Practice, 7:21.

Health Literacy– A patient’s ability to obtain, understand and act on health information

11

Use simple “plain language” words that are easier to understand instead of medical terms.

Health Literacy—A patient’s ability to obtain, understand and act on health information

12

Medical Term Plain Language

Adverse Bad

Analgesic Pain killer

Hypertension High Blood Pressure

Lipids Fats in the blood

“Asking patients to recall and restate what they have been told” is one of 11 top patient safety practices based on strength of scientific evidence.

13

Teach Back

American Medical Association Health Literacy Video

14

Source: American Medical Association

• Use plain language• Repeat key messages• Summarize

Implications for Journalists

15

• UPMC’s Brand Manual provides font guidelines for all print and web content.

• Print:– All patient/visitor-facing body text must be sans serif and point size

13 (minimum).• Enhances readability for those with lower literacy levels.• Enhances readability for elderly patient population.

• Web:– A work in progress!

Font Type and Size

16

• Patient Experience uses print templates for standardization and consistency throughout the health system

• Templates allow for attention to health literacy and readability

• Partnership with graphic design team allows us to focus on content creation and editing

• Our templates include:– Panel cards– Fliers– Brochures– Booklets– Notecards

Print Templates

17

Font Types

18

Font Types

19

Headlines

20

Graphics

21

Graphics

22

Everything that we work on, including UPMC.com content, social media posts, and print materials, goes through a thorough health literacy review.

Our process includes a mixture of formal and informal techniques:•Health Literacy Advisor •Eyeballing

Assessing Readability

23

• Health Literacy Innovations (HLI), a privately-held company founded in 2006, offers plain-language software products and services to help communicators eliminate consumer confusion due to low health literacy.

• The Health Literacy Advisor (HLA) is a software tool to help assess and improve the readability of documents using plain language principles.

• The HLA was designed to save time:– Works entirely within Microsoft Word

– Has an easy-to-use interactive “readability-checker”

– Created for the health care industry, but works great on non-health care documents as well

Health Literacy Innovations™

24

Source: www.healthliteracyinnovations.com

• The HLA includes these readability indices:– Fry-Based Electronic Readability Formula– Precise SMOG– Gunning-Fog– Automated Readability Index (ARI)– Flesch-Kincaid Grade Level– Flesch-Kincaid Reading Ease– New Dale-Chall Formula– FORCAST Readability Formula– Coleman-Liau Index

Health Literacy Innovations™

25

Source: www.healthliteracyinnovations.com

• The grade reading level is calculated by the average number of sentences and syllables per hundred words.

• These averages are plotted onto a specific graph; the intersection of the average number of sentences and the average number of syllables determines the reading level of the content.

Fry-Based Electronic Readability Formula

26

Source: Gunning, T. G. (2003). Building Literacy in the Content Areas. Boston: Allyn & Bacon.

• The formula and graph are often used to provide a common standard by which the readability of documents can be measured.

• The Fry formula is preferred in health care because of the wide and varied population of patients. This formula ensures that publications have a readability level that is both understandable and accessible.

Fry Readability Formula

27

Source: Gunning, T. G. (2003). Building Literacy in the Content Areas. Boston: Allyn & Bacon.

• HLA has a built-in lexicon with plain-language alternatives and descriptions for more than 12,000 hard-to-understand words, phrases, and medical jargon.

• Operates as a search-and-replace function.

• Not a perfect science, but does provide alternative options if needed.

Search and Replace

28

• Our most tried and true scientific tool.

• Approach each document as if you were writing it for an elementary school class.

• If you use those hard-to-understand words, follow them up with an explanation.

Eyeballing

29

“Since there is no cure for lymphedema, risk identification and

prevention are key. One way to identify risk for lymphedema is

to evaluate all patients in the high-risk group before and after

surgery. Evaluation is done with standard measurement, and

available diagnostic tools, such as bioimpedance (non-invasive

method of determining the composition of body tissues to

evaluate the presence of body fluids such as lymph), and

lymphoscintigraphy (radiological imaging).”

Assessing for Readability – Walkthrough

30

Original Reading Level

31

Identifying High-Level Health and Non-Health Terms

32

Long and Complex Sentences

33

• To-do list:– Address high level words (both health and non-health terms)

• Lymphedema

• Identification

• Evaluate

• Standard

• Measurement

• Diagnostic

• Bioimpedance

• Non-invasive

• Composition

• Lymphoscintigraphy

– Address long, complex sentences– Re-evaluate the reading level

What Do We Do Next?

34

Lymphedema is when your arm or leg swells. This can happen after some cancer treatments because of fluid in your lymph nodes. Lymph nodes help your body to filter cancer cells. It is important to be able to look for signs of lymphedema so that you can tell your doctor right away.

There are ways for doctors to tell if you are at risk for this swelling before and after your surgery. They have special tools to see your body tissues and look for this fluid before it builds up in your body. These tools will not hurt you. They simply take images or scan your body for the information.

Revised Content – After Health Literacy Review

35

Final Verdict?

36

• One of our doctors offices said that many of their patients were having trouble understanding the urine collection directions.

• Our team suggested using the colloquial term for urine.

• Yes, this really happened. Yes, it worked!

• Feedback is key.

Plain Language Put to Use

37

• It is so important to incorporate the voice of the patient/visitor (our consumers) into all relevant materials.

• We have different methods of gathering patient feedback, including:– Focus groups– Pre-scheduled1:1 interviews– Waiting room interviews– Phone calls– User testing

Gathering Patient Feedback

38

When we conduct patient feedback we ask questions around readability, including:

1.Was the information useful? 2.Was it easy to read and understand?3.Did the information flow well to fit with your experience?4.Do you think that any information was missing?5.Was the font size large enough?6.Did you have enough room to write?7.Is there anything you wish you had known that we didn’t provide or explain?8.Did this information help you get ready for your experience?9.After reading this information, did you know what was going to happen to you?

Gathering Patient Feedback

39

• Continue to spread the word about health literacy and readability throughout our health system.

• Offer advice and support to our clinical partners around our goal – to ensure that all patient/visitor materials are reviewed for health literacy and readability.

• Continue to set the standard for best practices in patient education.

What’s Next for UPMC

40

Any questions?

Connie Feiler, RN, MSNSenior Manager, Patient Experience Team

Donald D. Wolff, Jr., Center for Quality, Safety, & Innovation at UPMC

412-647-9776

[email protected]

Sarah Kastelic, MACommunications Specialist, Patient Experience Team

Donald D. Wolff, Jr., Center for Quality, Safety, & Innovation at UPMC

412-864-4452

[email protected]

Thank You!

41