2. Cambridge Health Alliance is committed to the provision of high-quality, culturally, linguistically, and financially accessible health care for all. Cambridge Health Alliance

3. Services Area The Cambridge Health Alliance is an award-winning regional healthcare system. 3 Main Hospitals 20 Health Centers The system includes:  Somerville Hospital  Cambridge Hospital  Whidden Memorial Hospital There are also 20 smaller health clinics, the Cambridge Department of Public Health, and Network Health, a state-wide managed Medicaid insurance plan.

4. Cambridge Health Alliance  Primary service area is the region north and west of Boston, Massachusetts  More than half our patients speak a primary language other than English  More than 600,000 Ambulatory visits per year  Largest proportional provider of uncompensated care in Massachusetts (33%)

5.  Intensive patient education at initial visit  Concentration of patients who speak English as a second language  Cultural competency  Measure learning  Interpreter time  Interest in patient satisfaction What led to the development ?

6.  Massachusetts Department of Public Health, TB Prevention and Control  Cambridge Health - Cambridge Public Health Department – TB Clinic - Cambridge Hospital - Community Affairs Partners in TB Services

7.  77 different countries  4% of our patients have active TB disease  96% treated for Latent TB Infection  41% in the US less than 5 years Patients in the TB Clinic

8. How do we know that our patients understand?

9. Authorware modules allow for:  Flexibility  Learner interaction  Use of audio  Use of visuals  Data Collection Authorware is a multimedia software program that can deliver health information in different languages to patients with low literacy skills. What is Authorware?

10. Benefits to using Authorware module  Enhances the effectiveness of visit time with clinical provider  Engages hard to reach populations  Reduces clinical staff and medical interpreter time & cost for repetitive assessments/standardization  Systematically documents patient assessment and education scores  Enhance medical outcomes through comprehension and retention of patient instructions and health information.

11.  Script development TB, RN’s, MD’s and Developer  Literacy Level Assessment  Culturally competent assessment by medical interpreters  Patient focus groups to test content  Translations  Module Development  Testing  Evaluation (Patient Satisfaction & Understanding) Process for Module Development

12. TEXT Before doctor visit, patients were asked to use a 20 minute module.  Pre Test in Module  Post Test in Module  Post Provider Interview conducted by an evaluator Authorware Patients Usual Patients Providers The Pilot – Evaluation & Planning Strategy Patients received TB Education from medical staff during visit.  Pre Test verbal interview conducted by evaluator prior to seeing provider  Post Test Interview conducted by an evaluator Patients received TB Education from medical staff during visit.  Pre Test verbal interview conducted by evaluator prior to seeing provider  Post Test Interview conducted by an evaluator GROUP #1 GROUP #2 GROUP #3

13. Authorware Demo

14. Our Findings  Challenges  Summary - What does the data say?  Recommendation  Next Steps

15.  Requires sufficient private space and thought about how to integrate into the clinic flow  Equipment cost (PC, Touchscreen, Printer)  Requires dedicated staff Challenges

16.  Authorware patients were able to answer basic information questions about TB better than usual practice patients.  Authorware patients seemed to have a more positive learning experience, and were more confident and enthusiastic in their understanding of TB and their ability to ask questions of their providers.  Authorware patients seemed more prepared to ask questions of their providers.  Authorware patients were more likely to feel strongly that they learned what they wanted to learn about TB. Summary - What does the data say?

17. Recommendations  Incorporate into clinical flow  restructure patient appointment times to incorporate module  establish policies for including module in visits (examples: space, login procedures)

18. Contact Information Yadira Ramos Software Developer - Authorware Office: 617.591.6944  Fax: 617.591.6949 The Cambridge Health Alliance- Department of Community Affairs 230 Highland Avenue, Somerville, MA 02143