Health Literacy Past, Present, and Future: Workshop Summary (2015) / Chapter Skim
Currently Skimming:
4 Use and Delivery of Health Care
4 Use and Delivery of Health Care
Pages 27-50
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 27... ...
George Isham, senior advisor at HealthPartners, then discussed the link between health literacy and quality of care, and Russell Rothman, director of the Center for Health Services Research at Vanderbilt Univer sity, described ongoing efforts to create health-literate health care delivery. V ictor Wu, managing director for clinical transformation at Evolent Health, provided some insights into the effects of the ACA on the health literacy field.
|
From page 28... ...
There has also been a move from local exploration toward some examples of broader implementation, and he commented that the implementation of quality findings in health care in general is itself an emerging science that has developed over the past decade and is still developing. The incorporation of health literacy principles into training standards is also just beginning, and he added that, "you can build a workforce, but you also have to train providers to communicate effectively and this will require cultural transformation." Paasche-Orlow said that the inclusion of core health literacy concepts such as universal precautions and teach-back that Howard Koh mentioned in his presentation are an important part of this cultural transformation, one that all clinicians are going to have to endorse and embrace and see as part of their mission.
|
From page 29... ...
The Health Resources and Services Administration (HRSA) quality toolbox website defines quality improvement as the systematic and continuous improvement in health services or health care services and the health status of targeted patient groups.
|
From page 30... ...
Today, with the advent of the ACA and the increasing stress on community-wide efforts to improve health, the definition of health services needs to include other socio conomic factors such as culture, education, and employment. e As an example, Isham remarked that his organization has an emphasis on children's health that goes far beyond clinical care to include how to work with other agencies in the community around education and early childhood development.
|
From page 31... ...
He then focused on the National Quality Strategy, a product of the ACA, and its three big areas of emphasis related to the triple aim of better care, affordable care, and healthy people and communities. Better care means improving the overall quality of care by making health care more patientcentered, reliable, accessible, and safe, while the focus on healthy people and communities aims to improve population health by supporting proven interventions to address behavioral, social, and environmental determinants of health, in addition to delivering higher quality care.
|
From page 32... ...
This strategy also recognizes that higher literacy skills in general do not necessarily equal better understanding, that health literacy is a state rather than a trait, and that everyone benefits from clear communication regardless of their health literacy status. AHRQ, Isham added, has developed the health literacy Universal Precautions Toolkit, which includes 20 tools, a quick start guide, a path to improvement, and more than 25 resources such as sample forms, owerPoint presentations, and worksheets (DeWalt et al., 2010)
|
From page 33... ...
FIGURE 4-2 Ten attributes of a health-literate organization.
|
From page 34... ...
The majority of these studies, he explained, focused only on individual health literacy or patient-provider communication and did not consider larger system-level challenges related to health literacy despite the paradigm shift that Koh referred to regarding the need to think about health literacy at the health system or organizational level. "When a patient interacts with a health care system, yes they are communicating directly with a provider, but there are many other facets of that organization that are at play and that impact the patient's health," said Rothman.
|
From page 35... ...
The aim of the work that the Roundtable commissioned was to identify and evaluate current measures for assessing organizational health literacy, and to try to reach out to health care organizations to understand how they are measuring and addressing organizational health literacy. Toward that
|
From page 36... ...
This search included all English-language articles from January 2004 to February 2014 and focused on measures of health literacy at the organizational level, excluding those papers and abstracts that looked at measures of individual health literacy and review articles. Recognizing that this is a young field, the Vanderbilt team also searched the so-called gray literature using Google search and by reaching out to experts in the field using listservs and a snowball sampling process to try to identify additional measures that organizations might be using.
|
From page 37... ...
checklist staff Health Plan Organizational >100 Designed by America's Health Insurance Plans Survey Organization X X X X X X Assessment of Health Literacy (AHIP) to assess health literacy appropriateness of Activities insurance materials provided to patients.
|
From page 38... ...
Rothman said that the 12 robust measures for addressing organizational health literacy are more than he expected to find when he and his colleagues started this project. "Several of the measures were developed specifically to address organizational health literacy, but others were originally developed to try to address how patient-centered an organization was or whether or not an organization was meeting criteria for patientcentered medical home.
|
From page 39... ...
USE AND DELIVERY OF HEALTH CARE 39 FIGURE 4-4 The Enliven tool's checklist measuring whether an organization is meeting the definition of attribute one. SOURCE: Thomacos and Zazryn, 2013.
|
From page 40... ...
The Communication Climate Assessment Tool has been accessed widely and the Health Plan Organizational Assessment of Health Literacy, which was developed by American Health Insurance Plans, has also been distributed nationally. This assessment tool was developed by a health literacy task force drawn from the organization's 65 member plans to look at how health plans address health literacy.
|
From page 41... ...
Sutter Healthcare is now using this amalgam to try to measure how it is addressing organizational health literacy to help drive organizational change. Other examples include Novant Health and Carolinas HealthCare System, both of which are using the AHRQ Universal Precautions Toolkit and the CAHPS measures to try to assess health literacy at their organizations and make changes in their organizations to address it.
|
From page 42... ...
HEALTH LITERACY AND THE AFFORDABLE CARE ACT4 In this session's final presentation, Victor Wu focused on the impact of the ACA on vulnerable populations, particularly with regard to how the concept of health literacy is being brought to bear to address the demands and complexities of health insurance enrollment. The ACA, he noted, has transformed access to health insurance, which comes as no surprise given all of the attention devoted to trying to enroll individuals who had previously been locked out of the health insurance marketplace.
|
From page 43... ...
Finally, said Wu, a framework for health insurance enrollment should also include measurement and evaluation that provides helpful, meaningful, and actionable information to improve the entire enrollment process.
|
From page 44... ...
One of the strategies that organizations have taken in response to this type of learning behavior is to create opportunities for multiple touch points during the enrollment process, and to go along with that, they establish multiple convenient and consistent times and locations at which individuals can get help. Wu noted that it may take at least four interactions before an individual will sign up and think about using their health insurance, which makes it important for individuals to know where and when in their community they can interact with the enrollment process.
|
From page 45... ...
"Comprehensive conversations regarding the cost and affordability of health insurance must be constructed and incorporated to help ensure successful signup and retention," said Wu, who explained that in practice this means equipping the navigators and assisters with the right material for the right consumer at the right encounter. Diagnosing and filling knowledge gaps to help better approach and meet consumers where they are in terms of their level of understanding is, Wu said, essential.
|
From page 46... ...
He also wondered if that was something the Roundtable could discuss and catalyze. Rothman replied that the Roundtable should encourage and move forward with pushing for organizations to measure organizational health literacy and to do so in a way that helps organizations make these measurements in a robust way that optimizes the opportunity for evaluation.
|
From page 47... ...
"Ultimately, we need to make the link that addressing organizational health literacy does ultimately lead to improved patient health outcomes," said Rothman. Isham remarked that the Vanderbilt group's work and the resulting paper has been helpful in describing where the field is with respect to measurement, and he agreed with Rothman that until there are organizations using a subset of these measures in a way that is consistent and that they can share with one another, the field will not quite be at the point to have broad-scale assessment of organizational health literacy.
|
From page 48... ...
research community should consider. Isham remarked that the universal precaution strategy is one way, albeit a blunt one, to address that challenge, but that it can be used to tailor an approach to individuals based on health literacy skills.
|
From page 49... ...
He also commented that there is an interesting aspect to the issue of informing people how to use their new health insurance, and that has to do with the behaviors that the chronically uninsured have developed and that may be barriers to getting the care they needed. These b arriers may include failure to obtain preventive care, lack of a primary care physician, or use of the emergency room for routine care.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.