Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Ch

1. Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month November 18th Lane Stiles LSTILES1@Fairview.org MN Health Literacy Partnership “Health Literacy & Patient Education” Questions? Want to be a panel member? Have suggested topics ? Contact: Skip Valusek MHQP Education Chair skipvalusek@comcast.net Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html

2. Hopefully you provided your name & organization when you signed in. If so: Just say Hi in the Chat Pod and we’ll capture your name and organization in the log. If not: identify yourself and organization in the Chat Pod to the left of your screen. Register your Attendance

3. Rural / Outstate ? Metropolitan area ? Organization that has (or serves) both ? Poll: Who is Attending this Session ? 3 3 1

4. Healthcare system Hospital Clinic or Clinic System Long term care Healthplan Homecare / Hospice A Quality Support Organization Other ? (e.g. MCM ) Poll: Who is attending: Organization Type ? 3 1 2 1

5. 1 2 3 4 5 6 7 >7 Poll: How many total participating in your room ? 7 1 2

6. I am a healthcare quality professional and am interested in additional education. I am a healthcare professional interested in developing quality skills as a core competency. I am a healthcare professional interested in learning more about healthcare quality. Poll: What do you hope to gain by participating? 9

7. About Lane Stiles: • Lane Stiles is Director of Fairview Press, a division of Fairview Health Services • Produces and manages patient information and translated materials. • Reviews and formats printed patient communications for readability. • Stiles is a member of the • Operations Committee of the Minnesota Alliance for Patient Safety • steering committee (and vice chair) of the Minnesota Health Literacy Partnership • steering committee of the Exchange • Patient Education SIG of the Minnesota EPIC Users Group

8. About MN Health Literacy Partnership • A collaboration of health care organizations, consumers, and literacy groups in Minnesota. Formed in January 2006 to help coordinate health literacy efforts across the state. • Goals: • Educate health care providers about health literacy • Empower consumers to ask for clear health communication • Share health literacy resources

9. AHRQ Health Literacy Universal Precautions Toolkit http://www.ahrq.gov/qual/literacy/

10. What is health literacy? • “the ability to obtain, process, and understand health information to make informed decisions about health care.” Involves using literacy as well as other skills (e.g., numeracy, listening) to perform health-related tasks. • Over one third of adults has limited health literacy (basic or below basic health literacy levels). Limited health literacy is associated with medication errors, increased health care costs, and inadequate knowledge and care for chronic health conditions.

11. What are universal precautions? • Taking actions that minimize risk for everyone when it is unclear which patients may be affected. • For example, health care staff take universal precautions when they minimize the risk of spreading blood-borne disease by using gloves and proper disposal techniques.

12. Why take universal precautions when it comes to health literacy? • Providers don’t always know which patients have limited health literacy. Some patients with limited health literacy: • Have completed high school or college. • Are well spoken. • Look over written materials and say they understand. • Hold white collar or health care jobs. • Function well when not under stress. • Research shows that clear communication improves care for all patients regardless of their level of health literacy.

13. How will promoting health literacy improve health outcomes? • To obtain optimal health outcomes, people need health care access, health knowledge, and behavior change. • Four change areas that are important for promoting health literacy: • Improve spoken communication. • Improve written communication. • Improve self-management and empowerment. • Improve supportive systems.

14. The Shape of the Toolbox Improved Health Outcomes

15. Key Change 1: Improve spoken communication. • Patients understand and retain about 50% of what they hear. This can have an enormous impact on patient safety and adherence. • Those with limited literacy are less likely to: • Ask questions during the medical encounter. • Seek health information from print resources. • Understand medical terminology and jargon. • Increased pressures on clinicians limit the time they are able to spend with patients.

16. Tools for improving spoken communication • Tips for communicating clearly (Tool 4) • Teach-back (Tool 5) • Follow-up with patients (Tool 6) • Telephone considerations (Tool 7) • Brown Bag medication review (Tool 8) • Addressing language differences (Tool 9) • Culture and other considerations (Tool 10)

17. Tool 4: Tips for communicating clearly • Warm greeting • Eye contact • Plain, non-medical language • Slow down • Limit content • Repeat key points • Graphics

18. Tool 5: Teach-back • 40-80% of the information patients receive is forgotten immediately and nearly half of the information retained is incorrect. • One of the easiest ways to close the gap of communication between clinician and patient is to use “teach-back,” also known as the “show-me” method or “closing the loop.” Teach-back is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands.

19. Tool 6: Follow-up with patients • Follow-up: making contact with a patient or caregiver of a patient at a later, specified date to check progress regarding a change or action that took place at last appointment or contact. Can be used for: • Monitoring health • Reinforcing knowledge and action plans • Confirming medication adherence • Scheduling appointments • Verifying follow-through on referrals • Reporting lab results. • Increase patient satisfaction as well as adherence.

20. Tool 7: Telephone considerations • Use a friendly, conversational tone of voice. • Speak clearly, at a comfortable pace. • Refer to the caller by name when possible. • Give callers your undivided attention, and try to avoid interruptions during the call. • Use teach-back when appropriate. • Encourage questions. • Use everyday words, and avoid medical jargon. • Use scripts when applicable for clear answers to common questions • Provide guidance to staff for answering questions when a script is not provided.

21. Tool 8: Brown bag medication review Patients bring all of their medications and supplements to medical appointments. Reviewing medications with the patient helps to: • Answer the patient’s questions. • Verify what the patient is taking. • Identify and/or avoid medication errors and drug interactions. • Assist the patient to take medications correctly.

22. Tool 9: Addressing language differences • An important part of addressing health literacy universal precautions. • Under Civil Rights Act of 1964 and subsequent federal and state laws and policies, a practice participating in Medicare or Medicaid is legally required to provide equal access to services for patients who do not speak or understand English well.

23. Tool 10: Culture and other considerations • Health beliefs and customs • Ethnic customs • Religious beliefs • Dietary customs • Interpersonal customs. • Expectations

24. Poll: How many of you have attempted to implement the following tools?(select all that you’ve attempted) • Tips for communicating clearly (Tool 4) • Teach-back (Tool 5) • Follow-up with patients (Tool 6) • Telephone considerations (Tool 7) • Brown Bag medication review (Tool 8) • Addressing language differences (Tool 9) • Culture and other considerations (Tool 10) 7 5 7 4 1 7 7

25. Poll: How many of you have successfully deployed the following tools?(select all that you’ve deployed) • Tips for communicating clearly (Tool 4) • Teach-back (Tool 5) • Follow-up with patients (Tool 6) • Telephone considerations (Tool 7) • Brown Bag medication review (Tool 8) • Addressing language differences (Tool 9) • Culture and other considerations (Tool 10) 2 0 2 2 1 4 4

26. Key Change 2: Improve written communication • Health care providers rely heavily on print materials to communicate with patients. • Many health-related documents are written at a college level, though most Americans read at the 8th grade level or below. • Studies show that those with limited literacy skills have difficulty understanding written information, including: • medication dosage instructions and warning labels • discharge instructions • consent forms for treatment and participation in research studies • basic health information about diseases, nutrition, prevention, and health services. • These things contribute to poorer outcomes and greater liability.

27. Tools to improve written communication • Designing easy-to-read materials (Tool 11) • Using health education materials effectively (Tool 12) • Welcoming patients: attitudes, signs and more (Tool 13)

28. Tool 11: Designing easy-to-read materials • Readability is affected by many factors: • Reading level • Organization • Relevance • Formatting • Motivation • Use designated communications specialists to write, edit, format, and manage written communications

29. Tool 12: Using health education materials effectively • Use in conjunction with spoken instruction. • Review the material with the patient. • Repeat and follow up. • Use multimedia.

30. Tool 13: Welcoming patients: attitudes, signs and more • Creating a friendly environment that is easy to navigate helps patients feel a sense of welcome and encourages their participation in the health care experience. • Evaluate • General environment • Front desk • Waiting rooms • Signage (universal signage developed by Hablamos Juntos)

31. Poll: How many of you have attempted to implement the following tools? (select all that you’ve attempted) • Designing easy-to-read materials (Tool 11) • Using health education materials effectively (Tool 12) • Welcoming patients: attitudes, signs and more (Tool 13) 9 7 7

32. Poll: How many of you have successfully deployed the following tools? (select all that you’ve deployed) • Designing easy-to-read materials (Tool 11) • Using health education materials effectively (Tool 12) • Welcoming patients: attitudes, signs and more (Tool 13) 8 3 6

33. Key Change 3: Improve self-management and empowerment • An important part of patient-centered medical care is enabling patients to share responsibility for their health and health care. Ultimately, it is the patients who have to adopt a healthy lifestyle and manage their chronic condition. • Limited literacy has been associated with poor adherence, self-care behaviors, and understanding of health information. Patients with limited literacy skills: • have poorer control of chronic conditions such as diabetes, HIV, and asthma • are less likely to ask questions or participate in the medical decisionmaking process.

34. Tools to improve self-management and empowerment • Encouraging questions (Tool 14) • Making action plans (Tool 15) • Improving medication adherence and accuracy (Tool 16) • Getting patient feedback (Tool 17)

35. Tool 14: Encouraging questions • An essential part of achieving good health outcomes is helping patients to understand that their role in their health care is important. But patients can sometimes be ashamed to ask questions, fearing that they will seem foolish. In some cultures, deference to authority figures stifles questions. • Create a shame-free environment • Ask Me 3 • AHRQ Questions Are the Answer

36. Tool 15: Making action plans Many patients have trouble taking the actions they need to maintain their health and manage their health conditions. An action plan, created by the patient and clinician, outlines a step the patient can take to attain a larger health goal. Action plans help patients integrate these steps or health behavior changes into their daily lives to achieve the goal, and they allow for patients to be actively involved in their own care. Research has shown that such plans are instrumental in bringing about behavior changes in patients. Quality Professional Thought: isn’t this our mantra . . . Don’t we live by action plans, deliverables, milestones ??

37. Tool 16: Improving medication adherence and accuracy Patients with limited health literacy are less likely to know how to take their medicine and have more difficulty following complex medication regimens. Helping patients understand medications and how to take them can reduce the number of medication errors. It can also increase patients’ ability to care for their illnesses, especially chronic illnesses.

38. Tool 17: Getting patient feedback Patients are in the best position to judge if a medical office poses health literacy challenges. Frequently, practices are unaware of the level of difficulty patients encounter in completing routine forms and navigating the health care system. Obtaining patient feedback allows patients to play an active role in identifying areas of improvement for health literacy.

39. Poll: How many of you have attempted to implement the following tools? (select all that you’ve attempted) • Encouraging questions (Tool 14) • Making action plans (Tool 15) • Improving medication adherence and accuracy (Tool 16) • Getting patient feedback (Tool 17) 3 3 5 6

40. Poll: How many of you have successfully deployed the following tools? (select all that you’ve deployed) • Encouraging questions (Tool 14) • Making action plans (Tool 15) • Improving medication adherence and accuracy (Tool 16) • Getting patient feedback (Tool 17) 3 1 2 5

41. Key Change 4: Improve support systems • Those with limited literacy are more likely to have additional risk factors for poor health and social and economic well-being. • Providers can link patients to community organizations and government agencies. These organizations can help patients with: • insurance coverage • medication assistance • case management • mental health services • basic adult education • support services for specific health needs (e.g., diabetes education, HIV/AIDS support groups, family planning services).

42. Tools to improve supportive systems • Linking patients to non-medical support (Tool 18) • Medication resources (Tool 19) • Using health and literacy resources in the community (Tool 20)

43. Tool 18: Linking patients to non-medical support Limited literacy affects all aspects of a patient’s life. Helping patients understand health benefits, get medications, and manage housing and transportation issues can be critical to achieving optimal health. Merely providing a list of support services and making referrals is not enough. Practices need to build into their system of care a commitment to make sure patients connect with needed services in a timely manner. Making sure this happens involves assigning responsibility for support activities, allocating staff time, and tracking outcomes.

44. Tool 19: Medication resources Medicine is often a vital ingredient to maintain health. Unfortunately, some patients may try to save money by going without their medicines or reducing the amount they take. Some larger pharmacies have recently helped the low-income consumer by offering many generic medicines at a lower price. But these programs do not always cover every medicine, and sometimes generic prescriptions are not appropriate for the situation.

45. Tool 20: Using health and literacy resources in the community • Minnesota Health Literacy Partnership, www.healthliteracymn.org • The Exchange, www.health-exchange.net • Minnesota Literacy Council, www.themlc.org • Stratis Health, Culture Care Connection, www.culturecareconnection.org

46. Poll: How many of you have attempted to implement the following tools? (select all that you’ve attempted) • Linking patients to non-medical support (Tool 18) • Medication resources (Tool 19) • Using health and literacy resources in the community (Tool 20) 2 2 4

47. Poll: How many of you have successfully deployed the following tools? (select all that you’ve deployed) • Linking patients to non-medical support (Tool 18) • Medication resources (Tool 19) • Using health and literacy resources in the community (Tool 20) 2 2 4

48. The path to improvement • Form a team (Tool 1) • Assess your practice and choose tools (Tool 2) • Raise staff awareness about health literacy (Tool 3) • Plan your changes

49. Tool 1: Form a team • Initiating and sustaining health literacy universal precautions in a practice requires strong, effective leadership and a clear strategy. The most effective teams include at least three categories of members: • senior leadership • clinical leaders • day-to-day leaders. • Highly recommended that patients and/or caregivers of patients be involved (reinforced last month as customer engagement best practice) .

50. Tool 2: Assess your practice and choose tools • Toolkit includes an assessment tool (provider assessment) • May also want to consider using the CAHPS Item Set for Addressing Health Literacy (patient assessment) • Goal is to identify strengths, barriers, and opportunities for improvement.