June 10, 2005

AMA AMA Health Literacy Policies and Health Literacy Policies and ProgramsPrograms

AMA AMA Health Literacy Policies and Health Literacy Policies and ProgramsPrograms

National Coalition for Literacy Policy Forum National Coalition for Literacy Policy Forum Washington, DC Washington, DC December 5, 2007December 5, 2007

Peter W Carmel, MD, D Med Sci

Professor and Chairman

Department of Neurological Surgery

The New Jersey Medical School

Newark, New Jersey

The New Jersey Medical School

1995 - JAMA publishes study: patients with low literacy have poorer health outcomes, with longer and more frequent hospitalizations*

1997 – AMA Council on Scientific Affairs – convenes national panel of experts – reports to AMA House

1998 – AMA creates new policy on health literacy, first national medical organization to do so

Early efforts

* Funded by R.W. Johnson Foundation

Limited patient literacy is a barrier to care

Encourages development of appropriate patient education materials

Work to make the healthcare community aware of large number of patients with poor understanding of health care information

Develop programs for med students, residents, and physicians to better communicate

Encourages compensation for patient education

Asks DOE to include questions on health literacy in National Adult Literacy Survey

Encourages federal and private funds for health literacy research

HOD - 1998

AMA Health Literacy Policy (H 160.931)

Foundation launches program, funded by a series of grants (Generous grant from Pfizer)

Creation (with partners) of the Health Literacy video/kit

Over 28,000 kits distributed

Train-the-Trainer curriculum; over 20,000 trained

Grant program for students, residents, practicing physicians, community groups

Website, newsletter, listserv, & PR

The Health Literacy Program – (AMA Foundation)

Evaluated the first two years of program by surveying physicians and found:• Approximately 2/3 of physicians who

responded were not aware of health literacy

• However, after learning about health literacy:93% ranked it as important to patient care65% reported making changes in their clinical

practice

• Approximately 14% learned about the issue from AMA Foundation

Increased awareness

• Mailed survey to 344 participants (2004)

• 126 returned (36.6%)

• 70% report having made changes in their practices

• 71% felt they had increased the quality of care they provided

Changed behavior

Reported Practice Changes After Training: 2004

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

DiagnosticPractices

TherapeuticPractices

Patient Monitoring Patient Education Communicationwith Patients

Any PracticeChange

Degree of Practice Change Reported: 2004

Area of Practice% Increased

% No Change

% Decreased

Asking patients to repeat back instructions

72.8% 27.2% 0%

Presenting 2 or 3 concepts at a time and checking for understanding

64.2% 29.6% 6.2%

Using simple language (avoiding technical jargon)

80.0% 20.0% 0%

Reading instructions to patients 47.4% 50.0% 2.6%

Speaking more slowly 70.4% 29.6% 0%

Conducting follow-up calls to check understanding and compliance

30.3% 69.7% 0%

Arranging for patients to have help with office forms

31.1% 68.9% 0%

Quality of care you provide 71.4% 28.6% 0%

Practice Change Reported: 2004

Three most useful steps:

The teach-back method

Avoiding technical jargon

Speaking more slowly

Most felt that they had increased the quality of care they provided

Second phase – Shift of focus from individual physician to system-wide effect

First health literacy textbook: “Understanding Health Literacy: Implications for Medicine and Public Health” Eds. Schwartzberg JG, Van Geest JB, Wang CC

We will publish results from NAAL report

Health literacy as a patient-safetypatient-safety issue Conference Monograph Tip cards

AMA Foundation Patient Safety and Health Literacy Initiative

Why should clinicians get involved and be willing to change their practices?

Must believe there is a serious problem and that change would help their patients or their practices.

Changes suggested must be compatible with values, beliefs and current practices.

Changes must be simple, easily adaptable.

Why are we at risk?

Unrealistic expectations of patients may lead to unintended medical errors

Increased malpractice riskUnrealistic expectations of effective staff-

staff communication may lead to medical errors

System failures, example: need for medication reconciliation.

AMA Foundation Patient Safety and Health Literacy Initiative

How can we change the current environment?

Recognize or anticipate potential patient harm or risk.

Mitigate or avoid risk through system change.

Develop patient-centric reactions to exposure to risk.

The Continuum of Confusion“Now, go home and manage your care.”

Schedule referral, tests, F/U

See BillingInsurance issue

Check-outNew medsSamples

TestsReferral

Instructions

Education w/MD/ RN

Pt LitChartsVideo

CD, etcAdjust medsRec medsNew meds

TestReferHosp

Back OfficeSince last appt:

ED/Hosp?New meds?

Better orWorse?

AppointmentSign-in:

Health, Fam, Med Hx?

AppointmentSign-in:

Insurance?Old forms?New forms?

Pre-visitProblem? Records?

Meds? Tests?

Directions?

Pre-visitSchedule appt:‘Press 1 for…’

The Patient

AMA Foundation Patient Safety and Health Literacy Initiative

Identify the potential harm and risks

Walk through the setting to note each communication interaction/opportunity

for misunderstanding

Patient’s “Continuum of Confusion”

Improving Communication to Improve Patient Safety.

Clinician-Patient Communication

Patient Education Materials

Disease Management Programs

Administration/Environment

/System Change National outreach, NPSF, “ask me three”

Module 1

SOAP-UP

The SOAP -UP NoteS – SubjectiveO – ObjectiveA – AssessmentP – PlanU – Use the “teach back” to check for understandingP – Plan for health literacy help

Vision

Healthcare providers and their staffs consider health literacy a

crucial force that improves patient safety.

Health literacy concepts are widely accepted in mainstream

clinical practice.

Our Mission:

To Help Physicians Help Their

Patients Understand

HEALING THE SYSTEM The AMA Plan to rescue U.S. Medicine