Clinical Screening of Patients’ Health Literacy
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Morehouse School of Medicine
Atlanta, Georgia
Hypertension
Comprehensive academic health care clinics
African Americans |
PROJECT
Patients complete a health literacy screening and physicians are trained to adjust their communication based on the results.
In the waiting room prior to their doctor visits, patients complete the Newest Vital Sign, a six-question screening tool which was developed as part of the Pfizer Clear Health Communication Initiative. Intake staff, nurses, and research assistants then enter the patients’ scores in their electronic medical records for the physician to see.
Physicians are trained to be particularly careful in their communication with patients with a health literacy score of lower than four, which indicates that they may have limited or low health literacy. Physician training utilizes the Health Literacy Educational Kit developed by the American Medical Association (AMA) Foundation which contains a documentary and instructional video, an in-depth manual for clinicians, the AMA Council on Scientific Affairs report on health literacy, literacy fact sheets, and materials for community presentations. Provider training includes familiarization with the screening tool and patient-provider role-playing exercises. Physicians are also given the option to complete the AMA Health Literacy Educational Kit as a self-study.
RATIONALE
Studies show that patients with low health literacy may be less adherent and less able to participate in their own disease management, resulting in poorer outcomes and health disparities. Patient adherence to prescribed treatment is crucial in managing chronic diseases such as hypertension. However, low health literacy is not simply a patient problem.
The implications for quality are shared by the provider and health care system in partnership with the patient. Communication is multi-directional, with the complexity of health care placing a greater burden on the clinician to ensure understanding. However, despite best efforts, clinicians are not always able to accurately assess literacy abilities of their patients and ensure their comprehension of the information provided.
By providing communications training and access to health literacy scores, physicians will be empowered to communicate with patients at an appropriate health literacy level, improving the encounter, quality of care and health outcomes.
EVALUATION PLAN
Funded by Finding Answers in 2006.
A multi-stage quantitative and qualitative evaluation is being conducted to assess the impact of health literacy screening on the clinical quality improvement program from both the clinicians’ and patients’ perspectives. In a randomized controlled trial, physicians are receiving either the intervention of health literacy training or, in the control arm, routine clinical quality improvement training as part of their regular grand rounds. A pre-post assessment of patients’ blood pressure compares levels at baseline and six months.
Patients are completing a questionnaire immediately after their visit with the physician and again six months later to assess their experience with the screening.
Publications
Verna L. Welch, Jonathan B. VanGeest and Rachel Caskey. Time, Costs, and Clinical Utilization of Screening for Health Literacy: A Case Study Using the Newest Vital Sign (NVS) Instrument.Journal of the American Board of Family Medicine. 2011; 24(3):281-289.
VanGeest, Jonathan B. , Welch, Verna L. and Weiner, Saul J.(2010) Patients' Perceptions of Screening for Health Literacy: Reactions to the Newest Vital Sign. Journal of Health Communication, 15:4, 402-412.
Resources
Newest Vital Sign: Six-question health literacy screening tool developed as part of the Pfizer Clear Health Communication Initiative
Health Literacy Educational Kit: Developed by the American Medical Association Foundation
For More Information
Please Contact:
Charlye Majett, MBA
cmajett@msm.edu
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