June 10, 2005 AMA Health Literacy Policies and Programs National Coalition for Literacy Policy Forum Washington, DC December 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

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 AMA Health Literacy Policy (H )

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 care 65% 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

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 patients47.4%50.0%2.6% Speaking more slowly70.4%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 provide71.4%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 patient-safety Health literacy as a patient-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 risk Unrealistic 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. The Patient Pre-visit Schedule appt: Press 1 for… Pre-visit Problem? Records? Meds? Tests? Directions? Appointment Sign-in: Insurance? Old forms? New forms? Appointment Sign-in: Health, Fam, Med Hx? Back Office Since last appt: ED/Hosp? New meds? Better or Worse? Adjust meds Rec meds New meds Test Refer Hosp Education w/ MD/ RN Pt Lit Charts Video CD, etc Check-out New meds Samples Tests Referral Instructions Schedule referral, tests, F/U See Billing Insurance issue

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 Patients 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 Note S – Subjective O – Objective A – Assessment P – Plan U – Use the teach back to check for understanding P – 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