1

Health Literacy Improvement: Policy and Practices

National Coalition for Literacy

December 5, 2007Linda Johnston Lloyd

Department of Health and Human Services (HHS)Health Resources and Services Administration

(HRSA)Center for Quality

2

America’s Health Care Safety Net

The Health Resources and Services Administration (HRSA), part of the U. S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.

HRSA’s bureaus and offices provide leadership and financial support to health care providers in every state and U.S. territory. HRSA grantees provide health care to uninsured people, people living with HIV/AIDS, and pregnant women, mothers and children. They train health professionals and improve systems of care in rural communities.

HRSA also oversees organ, tissue and bone marrow donation, maintains databases that protect the public against health care malpractice, and compensates individuals harmed by vaccinations.

3

How HRSA Serves America HIV/AIDS Bureau: Administers the Ryan White HIV/AIDS program, which funds primary health care, support services and life-saving medications for more than 530,000 low-income, uninsured and underinsured people living with HIV/AIDS.

Bureau of Primary Health Care: Manages the national health center network, which is comprised of about 1,000 grantees that operate community, migrant, homeless and public housing health centers. The grantees provide community-based, primary health care at 4,000 sites nationwide.

Maternal and Child Health Bureau: In partnership with States, MCH programs serve more than 32 million women, infants, and children each year. About 60 percent of U.S. women who give birth receive services through HRSA-supported programs.

4

How HRSA Serves America Bureau of Health Professions: In many areas, health care professionals are in short supply. BHPr helps train physicians, nurses and other providers and places them where they are needed most.

Healthcare Systems Bureau: Oversees the Nation’s transplant systems, helps communities respond to mass casualty events, and compensates families of children harmed by vaccines.

Bureau of Clinician Recruitment and Service: Administers programs such as the National Health Service Corps in which individuals accept loan repayments or scholarships in primary care training in exchange for service in medically underserved areas.

Office of Rural Health Policy: Administers grants and technical assistance that helps rural health care providers build coordinated systems of care that improve local residents’ access to medical services.

5

Why is Health Literacy Important?

“Assuring a safety net for individuals and families who live

outside the economic and medical mainstream is a key HRSA role”.

6

Health Literacy is a Common Denominator Secretary’s 500/5000 Day Plan

Consumers - better informed Wellness and prevention focus Community-based approaches to closing the healthcare

gap.

HRSA Strategic Plan Promote access to, and appropriate use of, health care

information Promote the development of a culturally diverse and

representative health care work force Promote outreach efforts to reach populations most

affected by health disparities

7

Joint Commission: “What did the Doctor Say?: Improving Health Literacy to Protect Patient Safety.”

“Effective communication is a cornerstone of patient safety,” says Dennis S. O’Leary, M.D., former president, The Joint Commission.  “If patients lack basic understanding of their conditions and the whats and whys of the treatments prescribed, therapeutic goals can never be realized, and patients may instead be placed in harm’s way.”

8

Promising Practices: Meeting the Joint Commission Recommendations

HHS Health Literacy Toolkit & Workgroup Activities

HRSA Training Course HRSA Grantees

Marilyn Disher- Presbyterian Medical Services (PMS) New Mexico

Laurie Francis- Community Health Partners South Central Montana

9

This paper provides three major recommendations

Recommendation I: Make effective communications an organizational priority to protect the safety of patients. Raise awareness throughout the organization of

the impact of health literacy and English proficiency on patient safety.

Train all staff in the organization to recognize and respond appropriately to patients with literacy and language needs.

10

HRSA’s Unified Health Communications Approach

“HRSA supports and promotes a unified health communications perspective that:

addresses cultural competency, limited English Proficiency, and health literacy in an integrated approach

in order to develop the skills and abilities needed by HRSA-funded providers and staff to deliver the best quality health care effectively to the diverse populations they serve.”1

1 HRSA POM- 2007-01: Cultural and Linguistic Competence, page one

11

Unified Health Communication Training Course: Main Screen

12

Course Information

Web-based, interactive course via HRSA Internet: http://www.hrsa.gov/healthliteracy/training.htm

HRSA provides the link to TRAIN for registration and the course content.

Course Length: 4-5 hours with ability to start and stop during course once you complete registration and the introductory module.

Cost: Registration and Course Completion Certificate: No Charge There may be charge from your accrediting body for CMEs, CNEs,

CEUs and CHES Credits. Printable documents to create your own workbook!

Glossary, Key Point Summaries, Readings, References and Job Aids to use in the future.

13

This paper provides three major recommendations

Recommendation II: Incorporate strategies to address patients’ communication needs across the continuum of care. Entry Health Care Encounter Transition Self Management

14

HRSA Grantees: Improving Health Literacyand Meeting Policy Recommendations

Putting together programs that are meeting: Culturally diverse population needs Many different languages spoken

Promoting access to education programs (Providers and patients)

Progress in improved health outcomes

15

Presbyterian Medical Services (PMS) New Mexico

Meeting the community needs

of the multi-cultural people of the

Southwest

Marilyn Disher 16

Presbyterian Medical Services

Presbyterian Medical Services designs and delivers quality, accessible, integrated health,

education, and human services in response to identified community needs of the multi-cultural

people of the Southwest.

UDS Grantee DemographicsAsian/Pacific Islander 0%

Black/African American 1%Native American 16%Hispanic/Latino 42%

White 41%Other 1%

PMS Staff DemographicsAsian/Pacific Islander <1%

Black/African American 1.2%Native American 12.6%Hispanic/Latino 37.1%

White 46.7%Other 1.9%

Marilyn Disher

17

Promising Practices

Project ECHO (“distance learning”)

[Extension for Community Healthcare Outcomes]

CLAS Project

[Culturally and Linguistically Appropriate Services]

Standardized forms

Marilyn Disher

18

Educational Outcomes

Project ECHO story Objective assessment of our clinics and staff reveal we are

ranking higher than we think in cultural competency efforts Availability of the CLAS training and ease of obtaining CEU’s is

motivational CLAS presentations given to our Clinical Directors once a year,

and individual sites have received visits from CLAS coordinator (“Anticipatory Guidance”) Patient Education and confirmation of

understanding instructions appears on several PMS standardized forms

Training/acclimating staff to respond to “prompts’ in preparation for EHR

Marilyn Disher

19

This paper provides three major recommendations

Recommendation III: Pursue policy changes that promote improved practitioner-patient communications.

Assisting patients in enrolling in adult education programs

Participation in Reach Out and Read (ROR) programs.

ROR encourages literacy promotion to become a standard part of the pediatric practice

Laurie Francis 20

Community Health Partners South Central Montana

Enhancing Community Health and Well-Being

Laurie Francis 21

Community Health Partners Staff education, early childhood education, adult ed., literacy

Opened doors in 1998 Started Reach Out and Read – 1999 Began Literacy Volunteers of

America (LVA) – 1999 Adult and Family Literacy

funding and programming, then Even Start

Joined many Health Disparities Collaboratives in past years. Diabetes, CVD, Depression, Access/Redesign, Oral

health, self management pilot Did research on depression – literacy connection…and cure. Imbedded literacy in health and health in literacy/education

22

Improved Health

OutcomesActivated

Patient/Client

Activated-Informed Provider/

Support TEAM

EXCELLENT CARE – Every Patient, EVERY timeEXCELLENT CARE – Every Patient, EVERY time•Timely access to provider team

•Clear Communication•Patient Priorities

•Data/evidence available to clinician and patient – Individual and panel management

•Follow up•Constant patient-centered system improvement

EXCELLENT CARE – Every Patient, EVERY timeEXCELLENT CARE – Every Patient, EVERY time•Timely access to provider team

•Clear Communication•Patient Priorities

•Data/evidence available to clinician and patient – Individual and panel management

•Follow up•Constant patient-centered system improvement

Patient-Centered, Patient-Centered, Provider Provider

Supported Supported CARECARE

Patient-Centered, Patient-Centered, Provider Provider

Supported Supported CARECARE

Health Literacy – A piece of the pieHealth Literacy – A piece of the pieImproving health outcomesImproving health outcomes in All in All PopulationsPopulations

Impact of SOCIETY*Poverty

*Education*Social equity

Impact of SOCIETY*Poverty

*Education*Social equity

23

Customer Satisfaction Cycle time Diabetes – A1cs, BPs CVD – BPs controlled Depression – PHQs completed SM Goals Set Patient Safety - Health Lit/Clear

Communication Tobacco Cessation Discussed

Community Health Partners: Outcomes…

in pursuit of the mission

24

Contact Information

For more information contact:

Linda Johnston Lloyd

ljohnston-lloyd@hrsa.gov

www.hrsa.gov/healthliteracy/