AMA Health Literacy Policies and Programs
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AMA Health Literacy Policies and Programs

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AMA Health Literacy Policies and Programs

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1. AMA Health Literacy Policies and Programs

2. Peter W Carmel, MD, D Med Sci Professor and Chairman Department of Neurological Surgery The New Jersey Medical School Newark, New Jersey

4. 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 AMA?s involvement in health literacy started in 1995 when the Journal of the American Medical Association published the results of a research study funded by Robert Wood Johnson Foundation. The study was conducted at Grady Memorial and LA General, two large public hospital systems; it demonstrated that patients with low literacy had poorer health outcomes, and longer and more frequent hospitalizations. In response to this issue, the AMA Council on Scientific Affairs requested that this issue be further examined. They convened an ad hoc committee of researchers in the field to do a comprehensive review of the science and impact of literacy on health. The committee?s report led to the AMA House of Delegates approving a health literacy policy, thereby making the AMA the first national medical organization to do so.AMA?s involvement in health literacy started in 1995 when the Journal of the American Medical Association published the results of a research study funded by Robert Wood Johnson Foundation. The study was conducted at Grady Memorial and LA General, two large public hospital systems; it demonstrated that patients with low literacy had poorer health outcomes, and longer and more frequent hospitalizations. In response to this issue, the AMA Council on Scientific Affairs requested that this issue be further examined. They convened an ad hoc committee of researchers in the field to do a comprehensive review of the science and impact of literacy on health. The committee?s report led to the AMA House of Delegates approving a health literacy policy, thereby making the AMA the first national medical organization to do so.

5. 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) AMA?s involvement in health literacy started in 1995 when the Journal of the American Medical Association published the results of a research study funded by Robert Wood Johnson Foundation. The study was conducted at Grady Memorial and LA General, two large public hospital systems; it demonstrated that patients with low literacy had poorer health outcomes, and longer and more frequent hospitalizations. In response to this issue, the AMA Council on Scientific Affairs requested that this issue be further examined. They convened an ad hoc committee of researchers in the field to do a comprehensive review of the science and impact of literacy on health. The committee?s report led to the AMA House of Delegates approving a health literacy policy, thereby making the AMA the first national medical organization to do so.AMA?s involvement in health literacy started in 1995 when the Journal of the American Medical Association published the results of a research study funded by Robert Wood Johnson Foundation. The study was conducted at Grady Memorial and LA General, two large public hospital systems; it demonstrated that patients with low literacy had poorer health outcomes, and longer and more frequent hospitalizations. In response to this issue, the AMA Council on Scientific Affairs requested that this issue be further examined. They convened an ad hoc committee of researchers in the field to do a comprehensive review of the science and impact of literacy on health. The committee?s report led to the AMA House of Delegates approving a health literacy policy, thereby making the AMA the first national medical organization to do so.

6. 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) Soon after this policy was passed, the newly re-organized AMA Foundation adopted health literacy as its ?signature program?. With a series of grants including a generous one from Pfizer, the program included: Partnering with researchers, adult literacy programs, adult learners, physicians, and other health care professionals to produce our health literacy video and the other materials contained in our health literacy kit. Publishing and distributing 28,000 of these health literacy kits. The kit is our primary method of educating physicians about health literacy. It?s used by medical schools, hospitals, medical societies, clinics, health centers, libraries, classrooms, and community organizations all over the US and internationally. We also developed a 1? day-long Train-the-Trainer curriculum. We?ve conducted four Train-the-Trainers, and trained teams of physicians and health care professionals from various state, county, and specialty medical societies, government agencies, universities, hospital systems, and residency programs. From our evaluation, we estimate we?ve reached over 20,000 people with these health literacy trainings. As part of the program launch, we awarded our own health literacy grants to medical students, residents and fellows, practicing physicians, medical societies, and community organizations. The grants helped support health literacy projects on issues such as medication safety, end-of-life care, patient education, and communication training techniques for medical students and physicians. Lastly, we developed a PR campaign to raise awareness about health literacy and to share information which included the launch of a Health Literacy Website, listserv, and newsletter. Soon after this policy was passed, the newly re-organized AMA Foundation adopted health literacy as its ?signature program?. With a series of grants including a generous one from Pfizer, the program included: Partnering with researchers, adult literacy programs, adult learners, physicians, and other health care professionals to produce our health literacy video and the other materials contained in our health literacy kit. Publishing and distributing 28,000 of these health literacy kits. The kit is our primary method of educating physicians about health literacy. It?s used by medical schools, hospitals, medical societies, clinics, health centers, libraries, classrooms, and community organizations all over the US and internationally. We also developed a 1? day-long Train-the-Trainer curriculum. We?ve conducted four Train-the-Trainers, and trained teams of physicians and health care professionals from various state, county, and specialty medical societies, government agencies, universities, hospital systems, and residency programs. From our evaluation, we estimate we?ve reached over 20,000 people with these health literacy trainings. As part of the program launch, we awarded our own health literacy grants to medical students, residents and fellows, practicing physicians, medical societies, and community organizations. The grants helped support health literacy projects on issues such as medication safety, end-of-life care, patient education, and communication training techniques for medical students and physicians. Lastly, we developed a PR campaign to raise awareness about health literacy and to share information which included the launch of a Health Literacy Website, listserv, and newsletter.

7. 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 care 65% reported making changes in their clinical practice Approximately 14% learned about the issue from AMA Foundation Increased awareness In the beginning, we had some success in raising awareness among physicians about health literacy. We surveyed physicians and found: Almost 2/3 of them were initially unaware of what health literacy was But after learning about it, 93% of them cited it as being important to patient care and 65% of them reported actually making changes in their own clinical practices. In addition, we found that 14% had learned about health literacy as a direct result from our efforts. We also learned that many other allied health professionals were interested in health literacy and using our materials to help spread the word.In the beginning, we had some success in raising awareness among physicians about health literacy. We surveyed physicians and found: Almost 2/3 of them were initially unaware of what health literacy was But after learning about it, 93% of them cited it as being important to patient care and 65% of them reported actually making changes in their own clinical practices. In addition, we found that 14% had learned about health literacy as a direct result from our efforts. We also learned that many other allied health professionals were interested in health literacy and using our materials to help spread the word.

8. 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 In 2004, we did a 6-month follow-up survey of people who participated in our first two Train-the-Trainer programs. We found that 70 percent reported having made changes in their practices, and 71% believed they had increased their quality of care.In 2004, we did a 6-month follow-up survey of people who participated in our first two Train-the-Trainer programs. We found that 70 percent reported having made changes in their practices, and 71% believed they had increased their quality of care.

9. Reported Practice Changes After Training: 2004 Of the reported practice changes, changes in the way physicians educated patients and changes in the physicians? interpersonal communication with patients ranked the highest.Of the reported practice changes, changes in the way physicians educated patients and changes in the physicians? interpersonal communication with patients ranked the highest.

10. Degree of Practice Change Reported: 2004 A large number of physicians reported that since the Train-the-Trainer, they began using different methods that had been recommended by our adult literacy advisors to address health literacy such as: the teach-back method, avoiding using technical jargon, and speaking more slowly, increasing the quality of care they felt they provided.A large number of physicians reported that since the Train-the-Trainer, they began using different methods that had been recommended by our adult literacy advisors to address health literacy such as: the teach-back method, avoiding using technical jargon, and speaking more slowly, increasing the quality of care they felt they provided.

11. Practice Change Reported: 2004 A large number of physicians reported that since the Train-the-Trainer, they began using different methods that had been recommended by our adult literacy advisors to address health literacy such as: the teach-back method, avoiding using technical jargon, and speaking more slowly, increasing the quality of care they felt they provided.A large number of physicians reported that since the Train-the-Trainer, they began using different methods that had been recommended by our adult literacy advisors to address health literacy such as: the teach-back method, avoiding using technical jargon, and speaking more slowly, increasing the quality of care they felt they provided.

12. Second phase ? Shift of focus from individual physician to system-wide effect Within the past couple of years, the AMA and AMA Foundation have begun to examine health literacy as it relates to patient safety. We have broadened our scope: from focusing on how an individual physician can improve their one-on-one communication with a patient - to how they can address health literacy at a system-wide level. One of the things we did was publish a health literacy textbook for medical and public health professionals. The book is the first of its kind to be developed as a teaching tool for not only practicing professionals, but for students as well. The book describes how health literacy is a larger, public health challenge. We also convened an advisory panel and hosted a conference to help advise us on how to strengthen patient safety through health literacy and patient understanding. From this, we printed and disseminated two new resources: our patient safety monograph and our patient safety tip cards. These resources provide tools to decrease communication-related adverse events at a system-wide level and help physicians initiate changes toward a safer, shame-free practice environment. Lastly, we will soon be publishing a report that describes the health literacy results from the landmark 2003 National Assessment of Adult Literacy. Our hope is that the report will help stimulate much-needed research among education, health, and policy experts.Within the past couple of years, the AMA and AMA Foundation have begun to examine health literacy as it relates to patient safety. We have broadened our scope: from focusing on how an individual physician can improve their one-on-one communication with a patient - to how they can address health literacy at a system-wide level. One of the things we did was publish a health literacy textbook for medical and public health professionals. The book is the first of its kind to be developed as a teaching tool for not only practicing professionals, but for students as well. The book describes how health literacy is a larger, public health challenge. We also convened an advisory panel and hosted a conference to help advise us on how to strengthen patient safety through health literacy and patient understanding. From this, we printed and disseminated two new resources: our patient safety monograph and our patient safety tip cards. These resources provide tools to decrease communication-related adverse events at a system-wide level and help physicians initiate changes toward a safer, shame-free practice environment. Lastly, we will soon be publishing a report that describes the health literacy results from the landmark 2003 National Assessment of Adult Literacy. Our hope is that the report will help stimulate much-needed research among education, health, and policy experts.

14. 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. They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do??? They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do???

15. Why are we at risk? Unrealistic expectations of patients may lead to unintended medical errors Increased malpractice risk Unrealistic expectations of effective staff- staff communication may lead to medical errors System failures, example: need for medication reconciliation. They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do??? They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do???

16. 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. They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do??? They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do???

17. The Continuum of Confusion ?Now, go home and manage your care.?

18. 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? They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do??? They are at risk for two key reasons: They have limited literacy skills, and this is compounded by the fact that? Our health care system is placing increasing demands on patients to manage their own care, making it more and more necessary for them to have advanced health literacy skills. Transition: So what can we do???

19. 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? We know that checking for understanding by using a ?teach back? technique in interactions with patients is effective.We know that checking for understanding by using a ?teach back? technique in interactions with patients is effective.

20. SOAP-UP The SOAP -UP Note S ? Subjective O ? Objective A ? Assessment P ? Plan U ? Use the ?teach back? to check for understanding P ? Plan for health literacy help

21. 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. In the past, we used to focus on what an individual physician could do during a patient encounter. Now, we?re expanding our scope to look at what a physician can do system-wide, whether they practice in an office, hospital, or university. With this broader evaluation of system-wide communication practices, we aim to prevent errors at every point of the patient visit ? from the time a patient schedules an appointment through the time the patient leaves the office. We are also concerned with ensuring that patients have the skills and understanding necessary to safely manage their own care. For the future, we envision health literacy to be an essential consideration in every step of patient care. That means we also envision health literacy becoming widely accepted into everyday practice. Our mission is to help physicians help their patients understand. Our health literacy program has always reached out to the entire community and we look forward to continuing to partner with all of you to achieve our mutual goals. Thank you.In the past, we used to focus on what an individual physician could do during a patient encounter. Now, we?re expanding our scope to look at what a physician can do system-wide, whether they practice in an office, hospital, or university. With this broader evaluation of system-wide communication practices, we aim to prevent errors at every point of the patient visit ? from the time a patient schedules an appointment through the time the patient leaves the office. We are also concerned with ensuring that patients have the skills and understanding necessary to safely manage their own care. For the future, we envision health literacy to be an essential consideration in every step of patient care. That means we also envision health literacy becoming widely accepted into everyday practice. Our mission is to help physicians help their patients understand. Our health literacy program has always reached out to the entire community and we look forward to continuing to partner with all of you to achieve our mutual goals. Thank you.

22. Our Mission: To Help Physicians Help Their Patients Understand In the past, we used to focus on what an individual physician could do during a patient encounter. Now, we?re expanding our scope to look at what a physician can do system-wide, whether they practice in an office, hospital, or university. With this broader evaluation of system-wide communication practices, we aim to prevent errors at every point of the patient visit ? from the time a patient schedules an appointment through the time the patient leaves the office. We are also concerned with ensuring that patients have the skills and understanding necessary to safely manage their own care. For the future, we envision health literacy to be an essential consideration in every step of patient care. That means we also envision health literacy becoming widely accepted into everyday practice. Our mission is to help physicians help their patients understand. Our health literacy program has always reached out to the entire community and we look forward to continuing to partner with all of you to achieve our mutual goals. Thank you.In the past, we used to focus on what an individual physician could do during a patient encounter. Now, we?re expanding our scope to look at what a physician can do system-wide, whether they practice in an office, hospital, or university. With this broader evaluation of system-wide communication practices, we aim to prevent errors at every point of the patient visit ? from the time a patient schedules an appointment through the time the patient leaves the office. We are also concerned with ensuring that patients have the skills and understanding necessary to safely manage their own care. For the future, we envision health literacy to be an essential consideration in every step of patient care. That means we also envision health literacy becoming widely accepted into everyday practice. Our mission is to help physicians help their patients understand. Our health literacy program has always reached out to the entire community and we look forward to continuing to partner with all of you to achieve our mutual goals. Thank you.

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


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