Patient Education Media Project

To Improve Healthcare Access and Health Outcomes for Medicaid Patients

Central Piedmont Access IIA Community Care of North Carolina Network covering

Davie, Forsyth, Stokes, Surry, Wilkes, and Yadkin Counties

September 16, 2005

Carol Gray Project Coordinator

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Table of Contents

Executive Summary 3

Business Information 4

Project Overview 4

Market Analysis 4

Market Strategy 9

Implementation Plan 11

Appendices 12

References 15

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Executive Summary

Health literacy refers to a patient’s ability to understand common health care communications to assure that the patient can be a full participant in managing his or her medical care with a health care provider. According to the Institute of Medicine Report on health literacy, 90 million people have difficulty understanding and using health information.1 People from all ages, races, and income levels are challenged by this problem. Individuals with low health literacy incur medical expenses that are up to four times greater than patients with adequate literacy skills, which result in additional health care costs in the billions of dollars every year for unnecessary medical visits and hospital stays.

Today, massive amounts of health care literature overwhelm and confuse health care consumers. This leads to health education that does not reach patients in an effective manner. Similarly, much of health care literature is not printed in plain language and easily read. The inevitable result is information overload, unsuccessful communication, and ineffective utilization of the health care system.

The purpose of Patient Education Media Project (PEMP) is to utilize alternative methods of communication, i.e. television and radio, to educate individuals about the appropriate ways to access health care services and where those services are located in the community. The combination of the following issues serve as the impetus for the PEMP: the rising health care costs of the Medicaid population; the core element of Central Piedmont Access II (CPAII) case management services is patient education; and the common, low literacy rate of the Medicaid population.

The target population of the PEMP is the Medicaid recipient population enrolled in the CPAII Program. The population resides in the six county region of the CPAII Program (Davie, Forsyth, Stokes, Surry, Wilkes, and Yadkin Counties). According to the August 2005 CPAII Enrollment Report, 41.8 percent is Caucasian and 57.7 percent is composed of minorities that include Hispanics and African Americans. The minority groups are more likely than Caucasians to experience difficulty communicating with their physician and to experience barriers to health care.2

The population will receive the message of the PEMP through radio and television commercials broadcast via numerous English and Spanish language stations. In addition, a short video will educate individuals on how to obtain health care services in a primary care provider (PCP) setting while patients sit within waiting rooms of select community health care organizations. The video will be viewed during the business hours of the organization. The identity and function of the PCP and CPAII case manager will be illustrated in addition to education on how the patient can benefit from the information printed on the Medicaid Card the patient receives every month.

CPAII will utilize funds from the operating budget received from the parent organization, Community Care of North Carolina (CCNC), for the PEMP. Specifically, the use of approximately $40 thousand dollars will be used to produce and broadcast the PEMP in English and Spanish over a period of 90 days. This period will begin once the production phase is complete. The production and broadcast vendors have not been selected, but vendors will be chosen in the near future based on their cost and quality effectiveness for the target population and optimal PEMP outcomes.

Success of the PEMP will depend on one or more of the following results: improved health outcomes for the target population; a reduction in emergency department (ED) visits and inpatient hospitalizations; and a reduction in health care expenditures determined within 6 to 12 months from the completion of the project. Subsequent media projects for CPAII or sister networks within CCNC are possible given the PEMP template. In the event the PEMP does not elicit the targeted health outcomes anticipated, other patient education vehicles of communication will be investigated.

1 http://www1.va.gov/visns/Visn02/vet/ed/pricare/Jan05PENews.pdf2 http://www.cmwf.org

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Business InformationCentral Piedmont Access II (CPAII) is a community care network of primary care providers committed to delivering excellent medical care for the Medicaid population in northwest North Carolina. CPAII is one of fifteen networks that compose the Community Care of North Carolina Medicaid Managed Care Program. CPAII has 46,000 enrollees over a six county region, (Davie, Forsyth, Stokes, Surry, Wilkes, and Yadkin Counties).

The primary mission of CPAII is to improve the access and quality of health care services for Medicaid recipients. The foundation of this mission is effective communication with Medicaid patients enrolled in CPAII on efficient ways to access health care services available in the local community. Inevitable results of improving communication methods are improved health outcomes and health care access for Medicaid recipients and their families. Similarly, a reduction in health care expenses is expected with a proportional reduction in unnecessary utilization of the health care system.

CPAII focus on the following to accomplish their mission. • Case managers work closely with enrollees, provider practices, and local community

organizations.• A system-wide education effort to help patients select the best place to receive care based on

their present health status.• Utilization of approved disease management protocols in an effort to optimize patient outcomes

and reduce unnecessary hospital admissions and emergency room encounters.

Project OverviewToday, massive amounts of health care literature frequently overwhelm and confuse health care consumers. This leads to health education that does not reach patients in an effective manner. Similarly, much of health care literature is not printed in plain language and easily read. The inevitable result is information overload, unsuccessful communication, and ineffective utilization of the health care system.

Historically, CPAII has relied on various forms of literature to inform providers, community organizations, and enrollees about its mission and services in the community. The combination of the following issues serves as the impetus for the PEMP.

• The core element of case management services is patient education. • The common, low literacy rate of the Medicaid population.• The rising health care costs of the Medicaid population.

Television and radio communication with enrollees will enable those with low literacy to understand how to access available health care services and where those services are located in the community.

Market AnalysisCPAII Demographic InformationThe target population of the PEMP is the Medicaid recipient population enrolled in the CPAII Program. According to the August 2005 CPAII Enrollment Report, 41.8 percent are Caucasians and 57.7 percent are composed of minorities that include Hispanics and African Americans. The minority groups are more likely than Caucasians to experience difficulty communicating with their physician and to experience barriers to health care.3

3 http://www.cmwf.org

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Other demographic characteristics of the CPAII population are that 55.1 percent are female and 44.9 percent are male with 94.4 percent who speak English and 5.6 percent who speak Spanish. 73 percent are aged 0 to 17 years, 25.4 percent are between 18 to 64 years; and annual incomes are between 100-185 percent of the Federal Poverty Level (FPL), which is $9,310 for a family of one and increasing by $3,180 with each additional family member.

Additional descriptive information about the CPAII population is shown below in the list of Medicaid categories provided by the Division of Medical Assistance (DMA).

• Aged, Blind, and Disabled Social Security Income Recipients• Infants born to Medicaid eligible women (to 185 percent of FPL)• Children under age 6 (to 133 percent of FPL)• Pregnant Women (to 150 percent of FPL)• All children born after 9/30/83 (to 100 percent of FPL)• Recipients of Adoption Assistance and Foster Care• Refugees/Aliens• Pregnant Women (150 to 185 percent of FPL)• Children age 18,19, and 20 meeting AFDC (Aid to Families with Dependent Children) income

standards (40 percent of FPL)• Special Needs Adoptive Children• Recipients of State Assistance to the Blind• Persons receiving care under home and community-based waivers• Medically Needy Persons• Women with Breast and Cervical Cancer (to 185 percent of FPL)• Certain Medicare Recipients

Dual Eligibles Qualified Medicare Beneficiaries Specified Low-Income Medicare Beneficiaries Qualified Disabled and Working Individuals4

LiteracyLiteracy is the single best indicator of health status when compared to age, income, employment status, education, or race. The problem of low literacy is one of profound magnitude in the United States (US) among all income and education levels. The National Adult Literacy Survey estimates that 22 percent of the total population score at the lowest literacy level (Level 1).5 Another source indicates that ninety million Americans (45 percent of the adult population) are functionally illiterate.6 Many of those who immigrate to the US in search of employment and a better way of life arrive with only limited literacy in their native languages. Basic literacy is not a problem limited only to health issues and concerns. The health care system can not solve the literacy problem alone.7 With this population not able to comprehend major concepts and tasks necessary to function in the health care system, the resolution of low literacy is of profound importance that requires educational support at all levels.

A direct relationship exists between low literacy (at or below 3rd grade level) and high health care costs. Literacy is a predictor of health care costs independent of other sociodemographic variables measured.8

The consequences of low literacy in relation to health and health care can mean that, despite the availability of health care services, both the awareness and the effectiveness of services received can be significantly reduced (if not eliminated).9 Specific consequences of inadequate health literacy include

4 http://www.dhhs.state.nc.us/dma/consinfo.htm5 Northwest AHEC; NC Latino Health 2003, Chapter 8, page 118.6 http://www.quic.gov/consumer/conference/molnar.htm7 Northwest AHEC; NC Latino Health 2003, Chapter 8, page 119.8 http://www.medscape.com/viewarticle/472536_print9 Tuckson RV, Keynote Address. Proceedings of Conference on Health Literacy: Advancing Public Policy (2000). January 18-19. Washington, DC: Pfizer (www.pfizer.com/hml/literacy/hl2), pp. 4-6.

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lack of use of preventive services, poorer self-reported health, poorer compliance rates, increased hospitalization, and increased health care costs.10

Health literacy refers to a patient’s ability to understand common health care communications, such as prescription instructions, test results, etc. to assure that the patient can be a full participant in managing their medical care with a health care provider. According to the Institute of Medicine Report on health literacy, 90 million people have difficulty understanding and using health information. People from all ages, races, and income levels are challenged by this problem. Individuals with low health literacy incur medical expenses that are up to four times greater than patients with adequate literacy skills, which result in additional health care costs in the billions of dollars every year for unnecessary medical visits and hospital stays.

To illustrate the magnitude of low literacy on a fundamental level, recent studies show that 86 percent of patients can not understand the rights and responsibilities of the Medicaid application.11 Similarly, the problem of health literacy may be growing more severe for Latinos as North Carolina has a higher proportion of Latino teenagers who have quit school – or bypassed it- than any other state. Nearly 47 percent of Latino youth in North Carolina between the ages of 16 and 19 are not enrolled in school and lack a high school diploma.12 Language barriers are the principal health care problem within the Latino community.13 In order to empower health care consumers of the choices available to them, effective communication with Medicaid patients indicates alternative communication methods need to be utilized, i.e. television and radio, utilizing both the English and Spanish language. Therefore, the lack of basic understanding on how to function in the health care system is the crux of the PEMP.

The Hispanic CommunityDue to the increasing prevalence of Hispanic patients within the Medicaid population, a closer look into the societal and cultural characteristics of the Latino community is significant to the success of the PEMP within the CPAII Network. For the purposes of the PEMP, the following definitions apply to the following terms.

• Hispanic : individuals who are of a Latin culture from numerous Spanish speaking countries (Central and South America, European, and African countries).

• Latino : individuals who are from Latin America (Central and South America) who speak Spanish. The Hispanic population is growing faster in much of the South than anywhere else in the US. Growing local economies have acted as a magnet for young, male, foreign-born Latinos migrating in search of economic opportunities.14 Latino immigrants have birth rates twice as high as those of the rest of the US population. The Census Bureau also found the Hispanic population in the US grew at a rate more than three times that of the general population in 2004.15 Between the years 2005 and 2020, Latinos are expected to account for about half the growth of the US labor force.16 More importantly, North Carolina had the fastest growing immigrant population of any state from the year 1999 to 2000.17 In Forsyth County, the Latino population is 19,577 (approximately 6.4 percent of the total population). The distribution of the Hispanic population by Type in the year 2000 is quite large for the Mexican born population (Fig. 1).18

10 http://www.hsph.harvard.edu/healthliteracy/literature/lit_2002.html#health

11 http://www.ama-assn.org/ama/pub/category/10363.html12 Raleigh News & Observer, November 4, 2002: 5B.13 Manson, A.B., Martinez, H.N.; North Carolina Medical Journal, November/December 2004, Volume 65, Number 6, p. 356.14 http://pewhispanic.org/reports/report.php?ReportID=5015 http://www.hispanicbusiness.com/news/news_print.asp?id=2445316 http://pewhispanic.org/reports/report.php?ReportID=4017 http://ciu.northcarolina.edu/docs/Latino_Initiative_PowerPoint.ppt#321,11,Slide 1118

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Mexican, 58.5%

Other Hispanic,

17.3%

Puerto Rican,

9.6%

Cuban, 3.5%

Spaniard, 0.3%

South

American, 3.8%

Central

American, 4.8%

Dominican,

2.2%

Figure 1. Percent Distribution of the Hispanic Population in the US by Type in the Year 2000

Similarly, North Carolina has a greater percentage of foreign born, non-citizen Latinos in comparison to national statistics (Table 1).18

Table 1. Origin of Latinos in North CarolinaNorth Carolina National

Mexican origin 71.1% 62.6%Foreign born 64.2% 45.1%Non-citizens 58.3% 31.5%Naturalized 5.9% 13.6%Speak English poorly or not at all 34.0% 21.9%Speak English less than very well 49.9% 36.3%

In addition to the rapid growth of Hispanic individuals in the Medicaid population, their access to health care services has also been shown to be problematic for optimal health outcomes. A study from Georgetown University shows that Hispanic adults report having difficulty accessing health care at a rate twice that of the general population.19 A contributing factor is due to the stressors they experience. These stressors include:

• Acculturative stress , most typically felt by immigrants who are faced with the turmoil of leaving their homeland and adapting to a new society.

• Socioeconomic stress , often experienced by ethnic minorities who feel disempowered because of inadequate financial resources and limited social class standing.

• Minority stress , which refers to the tensions that minorities encounter resulting from racism.

Another factor in the Hispanic population being able to access health care services relates to their status of citizenship. For example, undocumented immigrants and other lawful permanent residents who have recently arrived in the US are generally ineligible for publicly funded health insurance coverage. Although

18 U.S. Census, 2000 Supplementary Survey Summary Tables PCT006, PCT020.19 http://www.hispanichealth.org

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this policy deters Hispanic individuals from seeking care in a primary care setting, these individuals will seek care at local emergency departments of area hospitals and successfully receive health care due to federal regulations concerning health care services, i.e. EMTALA (Emergency Medical Treatment and Active Labor Act).

In addition, emergency department care is similar to rural clinics in traditional Hispanic culture in that individuals are used to dedicating a full day to see a physician. To illustrate this practice, it is common for Hispanic individuals to walk a great distance in their native land to see a doctor, sign in at the doctor’s office, and be seen after much time is spent waiting. This fact compounds the problem of inappropriate emergency department use here in the US, which is a more costly and less efficient method of treatment than that received in a primary care setting.

In addition to understanding the typical health care experience of the Hispanic population in their native culture, all cultural characteristics play a key role in a US community’s ability to influence behavior in a Hispanic patient. A study conducted by Reyes, Falcon, Van de Putte, and Levy found that language barriers and differences in cultural values can have a negative impact on the quality of care delivered and can negatively influence medication compliance, self-management of chronic disease, and overall health outcomes for many Hispanic patients.20 By better understanding the culture of the Hispanic community, the goal of high-quality primary health care that is accessible, effective, and cost efficient for all patients can be attained easier.

Specifically, the cultural nuances of the Hispanic population determine much about how to communicate with its individuals. Family involvement in a patient’s care is often critical to effective health outcomes. Patients use family for support when taking care of illness. Hispanics place great value on personal relationships, which is why most of their health care is received from community-based organizations and clinics. Building trust with the patient and their family is imperative. Over time, a physician can improve trust with a patient by showing a personal interest in and a respect for the patient’s health and their culture. The traditional patriarchal networks of the Hispanic society are mediated by respect, which implies a mutual and reciprocal difference between populations of different origin. Therefore, respect is an expectation of the population in all social interaction. Individuals of this population also tend to view health from a synergistic point of view that incorporates body, mind, and spirit.21 Health care messages and environments that exude these characteristics will have a greater chance of being received positively by the Hispanic population.

The perception of the Hispanic community on the need for health care is different than for individuals of other ethnicities. The need for preventive care is illustrated in a study done by Long Foley at Wake Forest University School of Medicine with Latina women in Forsyth County, which indicated that 31 percent of the population listed a chronic illness as the primary reason for their first visit to the doctor. Similarly, 9 percent of the population listed preventive services/screenings as the primary reason for their first visit to the doctor.22 The 2003 North Carolina Latino Health Report also found that Latinos do not fully understand the importance of obtaining regular, preventive services and may not have the insurance coverage needed to obtain such services.23 Therefore, the perceptions of the Hispanic population on their need for preventive care are quite different than individuals’ perceptions of US culture, which translates into a higher cost for health care in the Latino population.

In addition, the perception of Hispanics on medical treatment is equally different than for individuals of other ethnic origins. Frequently in Mexico, a home remedy is provided for all minor illnesses (i.e. fever, stomach ache, etc.). Here in the US, the doctor often tells the patient to “wait and see”, which is most dissatisfying to the patient. The population also has a fatalistic view of “God’s will prevails” when thinking about the pursuit of treatment options for fatal diseases such as cancer, which has a direct impact on their mortality.

20 http://www.hispanichealth.org/pdf/hispanic_report04.pdf#search='Reyes%2C%20Falcon%2C%20Van%20de%20Putte'21 http://erc.msh.org/mainpage.cfm?file=5.4.5a.htm&module=provider&language=English 22 Long Foley, K., Caprela Survey; Wake Forest University School of Medicine.23 http://www.nciom.org/projects/latino/latinopub/C4.pdf

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The health issues that plague this population are many. Latino children are more likely to be obese than other children and more likely than Caucasians and other minorities to have asthma.24 The population is also plagued with deaths from motor vehicle crashes, and is more likely to die of AIDS than Caucasians. Conversely, their rates of heart disease, cancer, and diabetes are much lower than the Caucasian and African American populations.25 Although experts indicate that as Latinos acculturate within the US, their health status specific to chronic illness is likely to suffer.

Market StrategyMessageThe characteristics of the target population will be addressed in the video and audio messages by the content and presentation of the subject matter via a clear and concise message. Specifically, the literacy level of the message will enable individuals with a 4th or 5th grade reading level of understanding to comprehend the fundamental components of the health care system in the local community. Other points to be addressed include the patient’s responsibility in seeking health care services, how to access these services, and how to access information about these services utilizing their Medicaid card.

Furthermore, a focused effort will be toward education on the appropriate use of the emergency department and on the identification of a “medical home” and their respective purposes. Similarly, education will be provided on CPAII’s function in the health care system and the CPAII case management services provided, as well as information on the patient’s responsibility when seeking health care.

The health care environment illustrated in the message will consist of happy, friendly, and welcoming health care staff members of varying ethnicities. These individuals will exemplify caring individuals that want to help patients and family members understand and resolve health concerns despite the patient’s ability to pay for services.

Hispanic MessageClearly, the characteristics of the Hispanic society and culture must be addressed in order to effectively communicate the health care information necessary to educate the population and influence their health care utilization behaviors. A similar message will be offered to the Hispanic community that is offered to the non-Hispanic or American community with a few enhancements that allow for a greater understanding of the message given the cultural differences that exist between American and Latino societies. The message will be provided in the Spanish language to eliminate the language barrier. In addition, the language will be given in a dialect of Mexican origin in order to reach the majority of individuals in the target population. Preventive care will be defined and emphasized for the population to receive at their “medical home”/PCP to improve health outcomes and reduce the cost of treatment for acute illness.

The message will consist of a health care environment that has the following enhancements to the original message previously outlined. The details of how the following enhancements will be illustrated and produced are forthcoming upon meeting with production designers.

• A larger extended family presence within the medical office.• A focus on the personal relationship between the patient and doctor, which may be illustrated by

the physician calling the patient by name and also by offering his/her hand in greeting at every office visit.26

• A focus on respect of the patient, their family and culture, which may be illustrated by smiling and speaking in an audible volume and tone.

• Instead of engaging the patient in making choices about their treatment options, direct medical advice will be provided with little decision-making responsibility given to the patient.

24 et al, Manson and Martinez, p. 356.25 Buescher P. State Center for Health Statistics. Presentation to NC Institute of Medicine Latino Health Task Force. June, 2002. Analysis of Death Certificate Data (1999-2000).26 http://www.omhrc.gov/clas/guide3a.asp

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• The provider will work to ensure the patient’s understanding of the prescribed treatment and expected outcomes.

• A focus on the mind, body, and spirit connection in the healing process.

Marketing PlanThe CPAII message for the PEMP is focused on television and radio communication broadcast through multiple broadcast stations that meet the target population’s demographic via market research performed through local television and radio broadcast companies. Various television and radio production companies have been contacted for proposals on the PEMP. For consistency in the message, a preference has been found for one company to do both the video and audio commercials. Conversely, cost estimates and other operational details of each company will be factored into the final decision on the appropriate production company to be used. Cost estimates from several production and broadcast companies were obtained and are provided (Appendix A). The companies chosen will be cost effective and committed to the delivery of a high quality product. The broadcast time and day of the CPAII commercials will be determined in collaboration with the broadcast company of choice.

Video A 5 to 8 minute video will be constructed that will play in the waiting rooms of physician practices, emergency departments, County Health Departments, Departments of Social Services, bus stations, and other community health care organizations that serve the Medicaid population. The use of Hispanic and African American talent will be utilized to represent the target population.

Examples of information about health care services and the patient’s responsibility in accessing services that will be included in the video are:

• A patient should become established with their Primary Care Provider (PCP) as soon as possible. • The patient calls their PCP before going to any other doctor.• The patient adheres to their scheduled appointment time with their PCP. • Use of the emergency department only when the patient feels their life or health is in immediate

danger. • Use the PCP for common illnesses and preventive care, such as health check screenings,

checkups and immunizations.• The patient will receive their Medicaid card every month. This is their insurance card. Everyone

in the patient’s family will receive a separate card. The patient should check their card every month to make sure the information on the card is correct. If the information is not correct, the patient’s case manager should be called immediately.

• The name of the patient’s doctor will be on the patient’s Medicaid card along with the office hours, phone number, and the after hours phone number of the doctor’s office.

• The patient should take their card to every doctor visit and show it to the receptionist. • The patient should call or meet with their case manager for any questions about health care

services or their health care condition.

Other points to be illustrated in the video include the following tips for clear communication with a physician during a medical visit.

• The patient should bring all medicines in one bag. • The patient should bring a list of all medical concerns.• The patient should bring a friend or family member to their appointment.

From the video, a television commercial will be constructed in either a 30 or 60 second length at a lower cost than would be achieved without the initial video. These commercials will not address the depth of issues addressed by the video, but will consist of no more than two or three of the major concepts listed in

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the previously mentioned patient education information points. Additional options of commercial length that evolve from the 30 or 60 second commercial foundation will be discussed further with producers. The opportunity to create additional commercials for the future exists (in subsequent months or years) at a relatively low cost given the original material contained within the initial video.

AudioA 30 or 60 second radio commercial will serve as a device to reach deeper into the market through less expensive advertisement buys provided on English and Spanish language stations. A Spanish language show, “The Peoples Clinic, La clinica del pueblo”, has agreed to provide time during the broadcast of the show, for the CPAII message via a guest speaker or by the broadcast of the patient education radio commercial. The show is broadcast on the Que Pasa Radio Station found at 1380 AM in Winston-Salem. Other radio stations within the community have indicated that a link to the CPAII website would be provided in addition to the broadcast in the event their station was selected to broadcast the CPAII patient education message.

Implementation PlanCPAII and the collaborating production and broadcast companies will utilize the next eight months to complete the PEMP. Subsequent media projects for the CPAII network are possible based on the success of the original project. Please see Appendix B for a timeline of the project from origination to completion.

Potential Risks and Regulatory IssuesMinimal risk exists for the CPAII network in using television and radio commercials. The only factor of concern is the terminology that is legally appropriate to describe the health conditions that qualify as emergent and non-emergent. The CPAII network’s legal advisors will consult with the media production team on the final script content that contains emergent health condition material to avoid medical liability issues that could otherwise result from the project. The patient will have a clear picture from the video and resulting commercials of when to seek treatment at their primary care doctor’s office and how to identify a life threatening condition, i.e. chest pain and/or severe bleeding.

Long Term DevelopmentThe success of the PEMP will depend on the following statistics of the CPAII pediatric and adult population. These statistics will be compared from the present or pre- PEMP to a post- PEMP phase that will cover six to twelve months from the completion of the 90 day broadcast period of the project.

• A reduction in total health care expenses • A reduction in the non-emergent visits to the emergency department of network hospitals • A higher visit frequency rate at the PCP• A reduction in the number of inpatient hospital admissions• A reduction in the acuity level of patients• A higher frequency rate of preventive screening exams, i.e. diabetic eye, foot, lipid exams, etc.

Once a successful outcome is demonstrated from the Patient Education Media Project, the Community Care of North Carolina Program may have an interest in a similar project for one or more other networks across North Carolina. Similarly, the pursuit of grant funds for future CPAII media projects would be probable for the benefit of Medicaid recipients.

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Appendices

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Appendix A: Patient Education Media ProjectVendor Bids

Video Audio TotalProduction

NC School of the Arts $15,100 $3,850 $18,950Loyel Studios $815Creative CommunicationsWallace Consulting

Broadcast Video

3 Months Frequency Spots 30 Sec.Per Unit Spots 60 Sec.

Per Unit

CBS, WFMY- 2 60 $8,555 $143 36 $12,300 $342Time Warner CableNBC- WXIIABC- WSOCFOX- WGHP

Audio

Frequency Spots/mthTotal Spots 30 Sec.

Per Unit 60 Sec.

Per Unit

La Movidita- WSGH 1040AM 45 135 $2,550 $18.89 $3,300 $24.44

97.1 FM- WQMG- Hip Hop2 weeks/mth 26 78 $9,330 $119.62 $12,000 $153.85

98.7 FM- SIMON WSMW3 weeks/mth 26 78 $5,490 $70.38 $7,200 $92.31

93.1 FM- WMQX Oldies4 weeks/mth 26 78 $6,180 $79.23 $7,800 $100.00

104 WTQR- Country 40 120 $12,960 $108.00 $17,760 $148.0099.5 WMAG- Easy Listening 40 120 $9,420 $78.50 $13,680 $114.00100.3 FM WVBZ- Classic Rock 40 120 $5,880 $49.00 $10,920 $91.0092.3 FM WKRR- Classic Rock 45 135 $11,475 $85.00 $11,475 $85.00107.5 WKZL- Top 40 45 135 $11,475 $85.00 $11,475 $85.00Gospel

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Appendix B: Patient Education Media Project Timeline

Task Start Finish Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06Proposal Submission 9/16/2005

Proposal Revisions/Approval -Begin Script 10/1/2005

All Vendor Bids Received

10/14/2005

Script Formulation 10/1/2005 11/1/2005

Decision Vendors to Use 11/1/2005

Meet with Vendors-Determine Content, Layout, Script 11/1/2005

11/15/2005

Production Time11/16/200

512/31/200

5

Evaluate/Revise Commercials 1/1/2006 1/6/2006

Final Edits, Review 1/9/2006 1/13/2006

Forward-Broadcast Companies 1/16/2006

Broadcast 2/1/2006 4/1/2006

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References

Websites

http://ciu.northcarolina.edu/docs/Latino_Initiative_PowerPoint.ppt#321,11,Slide 11http://erc.msh.org/mainpage.cfm?file=5.4.5a.htm&module=provider&language=Englishhttp://pewhispanic.org/reports/report.php?ReportID=40http://pewhispanic.org/reports/report.php?ReportID=50http://www.ama-assn.org/ama/pub/category/10363.htmlhttp://www.cmwf.orghttp://www.dhhs.state.nc.us/dma/consinfo.htmhttp://www.hispanicbusiness.com/news/news_print.asp?id=24453http://www.hispanichealth.orghttp://www.hispanichealth.org/pdf/hispanic_report04.pdf#search='Reyes%2C%20Falcon%2C%20Van

%20de%20Putte'http://www.hsph.harvard.edu/healthliteracy/literature/lit_2002.html#healthhttp://www.medscape.com/viewarticle/472536_printhttp://www.nciom.org/projects/latino/latinopub/C4.pdfhttp://www.omhrc.gov/clas/guide3a.asphttp://www.quic.gov/consumer/conference/molnar.htm

Publications

Buescher P., State Center for Health Statistics. Presentation to NC Institute of Medicine Latino Health Task Force. June, 2002. Analysis of Death Certificate Data (1999-2000).

Long Foley, K., Caprela Survey- National Cancer Institute (January 2004 - July 2005); Wake Forest University School of Medicine.

Manson, A.B., Martinez, H.N.; North Carolina Medical Journal, November/December 2004, Volume 65, Number 6, p. 356.

Northwest AHEC; NC Latino Health 2003, Chapter 8, pp. 118-119.

Raleigh News & Observer, November 4, 2002: 5B.

Tuckson RV, Keynote Address. Proceedings of Conference on Health Literacy: Advancing Public Policy (2000). January 18-19. Washington, DC: Pfizer (www.pfizer.com/hml/literacy/hl2), pp. 4-6.

U.S. Census, 2000 Supplementary Survey Summary Tables PCT006, PCT020.

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