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3 Improving Health and the Bottom Line: The Case for Health Literacy
Pages 15-28

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From page 15...
... He also noted that his team's plain language specialist revised the paper's executive summary so it could be understood by people outside of the field, and he thanked the more than 50 people he and his colleagues spoke with to find out what new evidence was available and identify best and promising practices that have not been published in the peer-reviewed literature. He 1  This section draws on a paper commissioned by the Roundtable on Health Literacy, Im proving Health and the Bottom Line: The Case for Health Literacy, by Stanton Hudson, R
From page 16...
... Most of the research that has been done, he said, has looked at short-term outcomes. There have been no longitudinal studies involving health literacy that examine long-term outcomes related to cost, quality, satisfaction, and effects of broad-based health literacy initiatives and interventions, which makes it difficult to identify causal relationships between health literacy and improved outcomes.
From page 17...
... For example, one health literacy intervention found that some 18 percent of individuals who received an automated phone call to remind them to have a cancer screening did, in fact, get screened, generating nearly $700,000 in additional income for the health system in 2 months. When Massachusetts General Hospital hired a community resource specialist, emergency department visits fell by 13 percent and realized a net annual savings of 7 percent, generating a return on investment of $2.65 for each $1.00 spent on the community resource specialist.2 Even something simple, such as giving parents the book What to Do When Your Child Gets Sick, produced savings of $1.50 for every $1.00 spent by giving parents easy-to-understand information on how to deal with their child's 2  Information available at http://www.partners.org/Innovation-And-Leadership/­ opulation P Health-Management/Current-Activities/Integrated-Care-Management-Program.aspx (accessed December 24, 2017)
From page 18...
... Combining online interactive media with automated phone calls produced a 15-day delay in readmission for chronic obstructive pulmonary disease and a 69 percent reduction in length of stay when patients did have to be readmitted to the hospital. Another study found that a patient navigator program for individuals with heart failure produced a 15.8 percent decrease in unplanned readmissions.
From page 19...
... Hudson said he was surprised how little literature there was that tries to understand the causal relationship between health literacy and medical errors. Perhaps the one exception is there have been quite a few studies showing that health literacy improves medication adherence and reduces medication errors (NASEM, 2017)
From page 20...
... He also explained that health literacy solutions do not have to be extensive or expensive. As examples, he cited rewording imaging and other diagnostic test reports, standardizing emergency department instructions, employing audio-recorded messages, and encouraging patients to bring a family member or friend to an appointment, all of which have been found to improve the patient's experience and satisfaction.
From page 21...
... In addition, he added, the 2016 CMS Quality Strategy includes two goals related to health literacy and health equity.3 Goal 1 calls for improving safety and reducing unnecessary and inappropriate care by teaching health care professionals how to better communicate with people who have low health literacy and by more effectively linking health care decisions to person-centered goals. Goal 3 calls for enabling effective health care system navigation by empowering individuals and families through educational and outreach strategies that are culturally, linguistically, and health literacy appropriate In Hudson's opinion, the implications of health literacy for health policy and practice are best laid out in the 2012 Institute of Medicine discussion paper Ten Attributes of Health Literate Health Care Organizations (Brach et al., 2012)
From page 22...
... • Understand the direct relationship between health literacy and medical errors, examine the causal link between health literacy and adverse events. • Examine the link between health literate organizations and p ­ rovider–patient communication, develop evidence on the direct relationship between health literacy and provider satisfaction.
From page 23...
... She also remarked that while research has largely focused on what the system must do and some on what the patient must do, there is little in the literature about family caregivers; but as society ages, family caregivers are going to play an increasingly vital role in health literacy. Lawrence Smith from Northwell Health stated that the health care system needs to teach patients two things: enough information about their illnesses so they can be legitimate partners with the health care system in the appropriate management of their illness, and equally important, how the health care system works.
From page 24...
... "We expect individuals to have these skills, but we do not teach them," he said. "If we truly wanted to teach health literacy, we would teach it in elementary and secondary school along with reading, writing, and math as a life skill everyone needs." In fact, when someone asked him the night before the workshop for the most innovative study he found, he singled out a study in which the researchers were "democratizing medical education" by taking what medical students would learn and including it in elementary and sec
From page 25...
... In response to Parnell's subsequent comment that medical schools are now doing better at teaching health literacy skills to medical students, Hudson said the problem is that similar efforts are not being made with attending staff and preceptors. "Students come out all gung-ho to use the teach-back method and they immediately get shut down by a doctor not understanding what they are doing, saying they do not have time for it," said Hudson.
From page 26...
... Hudson replied that the commissioned paper does include studies that looked at public health literacy interventions. He also noted that the Canyon Ranch Institute is using quality-adjusted life-years and similar measures to measure the effectiveness of interventions on cost and can identify extensive cost savings in that manner.
From page 27...
... Rikard mentioned there are studies of that type underway in Europe. Health Literacy Europe, he said, is implementing health literacy curricula in Europe's primary and secondary schools and studying what happens to those children over time.4 Audrey Riffenburgh from Health Literacy Connections noted that she recently met a professor at the Colorado State University College of V ­ eterinary Medicine and Biological Sciences who told her that the veterinary students all receive 50 hours of health communication skills as part of the standard curriculum.
From page 28...
... She suggested that these should be included in the business case because patients are more likely to return to a health care organization that communicates clearly. She also noted that changes in payment policies are providing new incentives that reward outcomes and positive patient experiences; these changes should become important pieces of the business case.


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