IMPLICATIONS OF HEALTH LITERACY ATTRIBUTES: THE PROVIDER’S AND HEALTH PROFESSIONAL’S PERSPECTIVE by Alexandra Ibewuike BS, University of Maryland, College Park, 2012 Submitted to the Graduate Faculty of Health Policy and Management Graduate School of Public Health in partial fulfillment of the requirements for the degree of Master of Health Administration
65
Embed
implications of Health Literacy Attributes: the …d-scholarship.pitt.edu/27488/1/Masters_Essay_4_2016... · Web viewIMPLICATIONS OF HEALTH LITERACY ATTRIBUTES: THE PROVEIDER’S
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
IMPLICATIONS OF HEALTH LITERACY ATTRIBUTES: THE PROVIDER’S AND HEALTH PROFESSIONAL’S PERSPECTIVE
by
Alexandra Ibewuike
BS, University of Maryland, College Park, 2012
Submitted to the Graduate Faculty of
Health Policy and Management
Graduate School of Public Health in partial fulfillment
of the requirements for the degree of
Master of Health Administration
University of Pittsburgh
2016
UNIVERSITY OF PITTSBURGH
GRADUATE SCHOOL OF PUBLIC HEALTH
This essay is submitted
By
Alexandra Ibewuike
on
April 1, 2016
and approved by
Essay Advisor:
Wesley Rohrer, PhD, MBA _________________________________Vice Chair of EducationDirector of MHA ProgramHealth Policy and ManagementGraduate School of Public HealthUniversity of Pittsburgh
Essay Reader:Mary Hawk, DrPH, LSW _________________________________Assistant ProfessorBehavioral and Community Health SciencesUniversity of Pittsburgh
Essay Reader:Kevin Progar, Project Manager _________________________________Regional Health Literacy Coalition University of Pittsburgh
Percentage of Respondents and Year Health Literacy implementation be -
gan
Figure 10: When Respondents Started Implementing Health Literacy
Question 12: In the years you began to implement health literacy programs, what changes were
observed?
The largest percent of respondents, 29%, reported that implementing the attributes affected the
improvement of patient outcomes, while 17% responded that the attributes helped reduce
readmissions.
26
Figure 11: Impact on
Metrics from Improving Health Literacy
*Other responses noted were the following:
- Improved consumer confidence and capability
- Greater understanding Importance of health literacy
- Provide training
- People return for help
- Insurance reimbursement
- Patient engagement
- Ability to do self-care
- Magnet (Perhaps becoming a magnet institution)
- Accreditation criteria
Question 13: If given more information about health literacy and the benefits of a program,
would you be more inclined to implement a program in your organization?
27
Improve
ment Patient O
utcomes
Less Readmiss
ion
Cost Decre
ase
ER Visits
Other
Unknown to
Org.
No Change
Improve
ment Patient S
atisfacti
onN/A
29%17% 14% 12% 10% 7% 6% 2% 2%
PERCENTAGE OF RESPONDENTS THAT SAY METERICS IMPROVED FROM IM-
PROVING HEALTH LITERACY
Metrics Impacted
% o
f Res
pond
ents
Similar to the BSCF study, if given more information and guidance, respondents expressed their
belief that individuals would be more inclined to participate in health literacy efforts. Figure 13
displays that 71% of respondents would be more willing to implement health literacy methods if
they knew the benefits of the programs.
Yes71%
No29%
Percentage of Respondents who would implement health Literacy with More in-
formation
Yes No
Figure 12: Percentage of Respondents Who would Implement Health Literacy with More Information on Health Literacy Benefits
Question 14 (2 Open-ended questions): What type of work have you done/witnessed that
promotes health literacy and what suggestions do you have to improve health literacy?
Responses are listed in Table 4. Collectively, the respondents provided 69 types of activities. The
most frequently reported activity was “teach back” which represented about 25% of the activities
mentioned.
28
Table 4: Respondents Reported Health Literacy Activities They have Witnessed
Health Literacy Promoting Activities
Education
- Statewide training Programs- Direct Patient Education- Educators/Researchers- Educate Medical and Nursing Students and
Health Professional- Present info at State Libraries- HL Advocate at Universities and Government
Agencies- ACA Information Training- Trained Librarians
Communication
- Re-create All Communication Materials- Standardize Patient Communication- Website Re-design with Health Literacy - Flyers and Workshops Promoting Health
Literacy- Discuss Health Literacy on TV Program- Call Back System- Plain Language- Work with Legal to Improve Readability
Organization/Services
- Health literacy Listserv- Health Literacy Taskforce- Provide Resources for limited English
Proficiency Patients- Work with Rural Elderly- Host a Health Literacy Forum- Leadership buy-in- Provider buy-in
Methods
- Administer Surveys- Teach Back Methods- Institution-wide Assessment- Evaluate Socioeconomic Factors- Hands-on Projects- Patient Empowerment programs- Ask Me 3- Ask-Tell-Ask- Mock Visits- Evaluate Effectiveness- System Collaborations
Policy- Health Literacy Policies- Principles of Writing Health Literate Patient Information- Add Health Literacy to Quality Improvement Projects
29
7. DISCUSSION
Studies suggest that of the 7 million readmissions that occur each year, about 12% of
them are preventable (Network for Excellence, 2015). Not all readmission are caused by
patient misapprehension but, as mentioned earlier in this report, about 33-69% of hospital
readmissions ware due to patient error. The current methods of prevention, like teach-back and
patient education, help reduce cost and risk of mortality by 35% and reduce readmission rates
(Quality Improvement for Institutions, 2016). The key take-away from this report is
understanding the impact an organization’s leadership has on the work environment and
culture. If a company’s leader is not in full support of a proposal or intervention, then it will
not be performed in the employee’s daily operations. Interestingly, the respondent’s
perceptions of how high their leadership prioritizes health literacy on a scale from 1-10 was
fairly high (56% rated between 6 and 10) and the mean response was 6. The survey results also
show a majority of survey respondents have a comprehension level on the 10 Attributes from
6-10 with a mean response of 7. However, the perception of the majority is that less than 25%
of the organizations’ employees actually understand the 10 Attributes. More surprisingly, 77%
of respondents reported that 4 or fewer attributes were used in their organization. This suggests
that providers understand the attributes but not many of their employees do. The survey results
also suggest that provider organizations are not utilizing all 10 Attributes to their fullest
potential to create health literate organizations. Perhaps these results suggest that leadership in
provider organizations are not doing enough in their organization to ensure their employees
fully understand and implement all 10 of the attributes.
I am proposing that effect incentives be provided for leadership to participate in
30
improving health literacy in their organizations. An example is to leverage Medicare
reimbursement in participating health institutions. If healthcare systems want to continue
benefiting from Medicare programs, then they should add health literacy to their quality
metrics. It should be the hospital’s responsibility to either adopt the teach-back method or
create their own intervention to help their patients understand and communicate better with
providers. Hospitals would benefit by reducing readmissions, costs of overutilization, and
increasing patient satisfaction. Patients would also benefit from an increased sense of
empowerment and control over their health, feel more confident when communicating with
providers, experience fewer visits to the emergency room, and deceased risk of mortality
caused by lack of knowledge on their health status.
8. CONCLUSION
31
In conclusion, the respondents from this survey are fairly confident in their understanding of
the 10 IOM attributes. However, not all attributes are implemented and some organizations may
not use any of the 10 Attributes. Also, the most common method of improving health literacy
that was reported was through “teach back.” Even though teach back is widely known to be
effective, the extent to which it is used is not known based on the survey alone. From this sample
we can conclude that the providers’ perceive health literacy to improve patient’s outcomes and
readmission rates and decrease costs. Although Healthy People 2020 noted health literacy as one
of the areas to improve in health care, it seems that there needs to be more work done to achieve
the commitment of leadership. As noted in one of the survey responses, “Without leadership
buy-in, it will be hard to promote and sustain an intervention.”
It is predicted that in the future, technology will help make health information more
accessible and perhaps more personalized (Alper, 2015). This begs the question, “What about the
populations that are more vulnerable and not tech savvy?” Such populations should have the
benefit of specialized care by using a communication style that caters to their needs and only
involving technology (like computerized programs) if the patient is comfortable doing so.
Although libraries may still be the best unbiased resource for many consumers, the Internet is a
powerful tool to provide valid and useful information that if presented effectively should be
comprehensible and easily accessible to health literate consumers (Alper, 2015). A
recommendation I propose is to create incentives to establish a Health Literacy Champion at all
Medicaid/Medicare participating facilities. This will encourage leaderships to make health
literacy a priority and in turn benefit from the impact of such an intervention (i.e. decrease in
readmissions, increased patient satisfaction etc.), creating a win-win situation for both patients
and providers. A second recommendation I propose is for the providers’ organizations to train
32
staff on the purpose, use, and implementation of the 10 Attributes to make their organization a
health literate health care organization. A fully trained staff in combination with the Health
Literacy Champion will ensure the organization’s served population will be more informed about
their health, more comfortable asking questions, more confident in making healthcare decisions.
APPENDIX
33
HEALTH LITERACY CLIMATE SURVEY
34
35
36
BIBLIOGRAPHY
1. Adler, Ben. News Literacy Declines Without Socioeconomic Status. Columbia Journalism Review. (2104). Web. 23 April 2016.
2. Alper, Joe. Health Literacy Past, Present, and Future: Workshop Summary. The National Academic Press. 2015. Web. 22 April 2016. <http://www.nap.edu/read/21714/chapter/7>
3. Blue Shield of California Foundation Survey. Empowerment and Engagement among Low-Income Californians: Enhancing Patient-Centered Care. 2012 Blue Shield of California Survey. (Sept. 2012).
4. Brach, Cindy et al. Ten Attributes of Health Literate Health Care Organization. June 2012. Institute of Medicine. Web. 19 Dec 2015 <http://www.ahealthyunderstanding.org/Portals/0/Documents1/IOM_Ten_Attributes_HL_Paper.pdf>
5. Centers for Disease Control and Prevention. Learn About Health Literacy. 30 Sept. 2015. Web. 27 March 2016 <http://www.cdc.gov/healthliteracy/learn/>
6. GSW Inventiv Health. Health Literacy Infographic. 2016. Web. 27 March 2016 <http://whatcouldbeday.com/infographics/140613_gsw_healthliteracy_infographic.pdf>
7. Haun, Jolie. Association between Health Literacy and Medical Care Costs In an Integrated Healthcare System: A Regional Population Based Study. BMC Health Services. (2015).
8. Neuhauser, Linda DrPH et al. Participatory Design of Mass Health Communication in Three Languages for Seniors and People with Disabilities on Medicaid. Dec 2009. Web. 19 Dec. 2015 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775764/>
9. Quality Improvement for Institutions. The Importance of Early Medication Management to Reducing Readmissions. 2016. Web. 28 March 2106 <http://cvquality.acc.org/~/media/QII/H2H/Getting%20Ready/3%20Med%20Management%20Evidence%20Slides.ashx>
10. Regional Health Literacy Coalition. About Us. (2016). Web. (March 2016). <http://www.ahealthyunderstanding.org/about-us>
11. Somers, Stephen and Mahadevan, Roopa. Health Literacy Implications of the Affordable Care Act. Centers for Health Care Strategies, Inc. (Nov. 2010).
37
12. The Network for Excellence in Health Innovation. Preventing Hospital Readmissions: A $25 Billion Opportunity. 2015. Web. 27 March 2016 < http://www.nehi.net/bendthecurve/sup/documents/Hospital_Readmissions_Brief.pdf>
13. University Center for Social and Urban Research. Health Literacy Survey of the Pittsburgh Metropolitan Statistical Area. Regional Health Literacy Coalition (September 2012).
14. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author. Web. 2016. <http://health.gov/communication/initiatives/health-literacy-action-plan.asp>
15. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Health Literacy Basics. 2016. Web. 27 March 2016 <http://health.gov/communication/literacy/quickguide/factsbasic.htm>
16. Wasson, John M.D., Eric Coleman, M.D MPH. Health Confidence: A Simple, Essential Measure for Patient Engagement and Better Practice. 2014.