1 Health Literacy Improvement: Policy and Practices National Coalition for Literacy December 5, 2007 Linda Johnston Lloyd Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Center for Quality

2 Americas Health Care Safety Net The Health Resources and Services Administration (HRSA), part of the U. S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable. HRSAs bureaus and offices provide leadership and financial support to health care providers in every state and U.S. territory. HRSA grantees provide health care to uninsured people, people living with HIV/AIDS, and pregnant women, mothers and children. They train health professionals and improve systems of care in rural communities. HRSA also oversees organ, tissue and bone marrow donation, maintains databases that protect the public against health care malpractice, and compensates individuals harmed by vaccinations.

3 How HRSA Serves America HIV/AIDS Bureau: Administers the Ryan White HIV/AIDS program, which funds primary health care, support services and life-saving medications for more than 530,000 low-income, uninsured and underinsured people living with HIV/AIDS. Bureau of Primary Health Care: Manages the national health center network, which is comprised of about 1,000 grantees that operate community, migrant, homeless and public housing health centers. The grantees provide community-based, primary health care at 4,000 sites nationwide. Maternal and Child Health Bureau: In partnership with States, MCH programs serve more than 32 million women, infants, and children each year. About 60 percent of U.S. women who give birth receive services through HRSA-supported programs.

4 How HRSA Serves America Bureau of Health Professions: In many areas, health care professionals are in short supply. BHPr helps train physicians, nurses and other providers and places them where they are needed most. Healthcare Systems Bureau: Oversees the Nations transplant systems, helps communities respond to mass casualty events, and compensates families of children harmed by vaccines. Bureau of Clinician Recruitment and Service: Administers programs such as the National Health Service Corps in which individuals accept loan repayments or scholarships in primary care training in exchange for service in medically underserved areas. Office of Rural Health Policy: Administers grants and technical assistance that helps rural health care providers build coordinated systems of care that improve local residents access to medical services.

5 Why is Health Literacy Important? Assuring a safety net for individuals and families who live outside the economic and medical mainstream is a key HRSA role.

6 Health Literacy is a Common Denominator Secretarys 500/5000 Day Plan Consumers - better informed Wellness and prevention focus Community-based approaches to closing the healthcare gap. HRSA Strategic Plan Promote access to, and appropriate use of, health care information Promote the development of a culturally diverse and representative health care work force Promote outreach efforts to reach populations most affected by health disparities

7 Joint Commission: What did the Doctor Say?: Improving Health Literacy to Protect Patient Safety.What did the Doctor Say?: Improving Health Literacy to Protect Patient Safety. Effective communication is a cornerstone of patient safety, says Dennis S. OLeary, M.D., former president, The Joint Commission. If patients lack basic understanding of their conditions and the whats and whys of the treatments prescribed, therapeutic goals can never be realized, and patients may instead be placed in harms way.

8 Promising Practices: Meeting the Joint Commission Recommendations HHS Health Literacy Toolkit & Workgroup Activities HRSA Training Course HRSA Grantees Marilyn Disher- Presbyterian Medical Services (PMS) New MexicoPresbyterian Medical Services (PMS) Laurie Francis- Community Health Partners South Central Montana Community Health Partners

9 This paper provides three major recommendations Recommendation I: Make effective communications an organizational priority to protect the safety of patients. Raise awareness throughout the organization of the impact of health literacy and English proficiency on patient safety. Train all staff in the organization to recognize and respond appropriately to patients with literacy and language needs.

10 HRSAs Unified Health Communications Approach HRSA supports and promotes a unified health communications perspective that: addresses cultural competency, limited English Proficiency, and health literacy in an integrated approach in order to develop the skills and abilities needed by HRSA-funded providers and staff to deliver the best quality health care effectively to the diverse populations they serve. 1 1 HRSA POM : Cultural and Linguistic Competence, page one

11 Unified Health Communication Training Course: Main Screen

12 Course Information Web-based, interactive course via HRSA Internet: HRSA provides the link to TRAIN for registration and the course content.TRAIN Course Length: 4-5 hours with ability to start and stop during course once you complete registration and the introductory module. Cost: Registration and Course Completion Certificate: No Charge There may be charge from your accrediting body for CMEs, CNEs, CEUs and CHES Credits. Printable documents to create your own workbook! Glossary, Key Point Summaries, Readings, References and Job Aids to use in the future.

13 This paper provides three major recommendations Recommendation II: Incorporate strategies to address patients communication needs across the continuum of care. Entry Health Care Encounter Transition Self Management

14 HRSA Grantees: Improving Health Literacy and Meeting Policy Recommendations Putting together programs that are meeting: Culturally diverse population needs Many different languages spoken Promoting access to education programs (Providers and patients) Progress in improved health outcomes

15 Presbyterian Medical Services (PMS) Presbyterian Medical Services (PMS) New Mexico Meeting the community needs of the multi-cultural people of the Southwest

Marilyn Disher16 Presbyterian Medical Services Presbyterian Medical Services designs and delivers quality, accessible, integrated health, education, and human services in response to identified community needs of the multi-cultural people of the Southwest. UDS Grantee Demographics Asian/Pacific Islander 0% Black/African American 1% Native American 16% Hispanic/Latino 42% White 41% Other 1% PMS Staff Demographics Asian/Pacific Islander <1% Black/African American 1.2% Native American 12.6% Hispanic/Latino 37.1% White 46.7% Other 1.9% Marilyn Disher

17 Promising Practices Project ECHO (distance learning) [Extension for Community Healthcare Outcomes] CLAS Project [Culturally and Linguistically Appropriate Services] Standardized forms Marilyn Disher

18 Educational Outcomes Project ECHO story Objective assessment of our clinics and staff reveal we are ranking higher than we think in cultural competency efforts Availability of the CLAS training and ease of obtaining CEUs is motivational CLAS presentations given to our Clinical Directors once a year, and individual sites have received visits from CLAS coordinator (Anticipatory Guidance) Patient Education and confirmation of understanding instructions appears on several PMS standardized forms Training/acclimating staff to respond to prompts in preparation for EHR Marilyn Disher

19 This paper provides three major recommendations Recommendation III: Pursue policy changes that promote improved practitioner-patient communications. Assisting patients in enrolling in adult education programs Participation in Reach Out and Read (ROR) programs. ROR encourages literacy promotion to become a standard part of the pediatric practice

Laurie Francis20 Community Health Partners Community Health Partners South Central Montana Enhancing Community Health and Well-Being

Laurie Francis21 Community Health Partners Community Health Partners Staff education, early childhood education, adult ed., literacy Opened doors in 1998 Started Reach Out and Read – 1999 Began Literacy Volunteers of America (LVA) – 1999 Adult and Family Literacy funding and programming, then Even Start Joined many Health Disparities Collaboratives in past years. Diabetes, CVD, Depression, Access/Redesign, Oral health, self management pilot Did research on depression – literacy connection…and cure. Imbedded literacy in health and health in literacy/education

22 Improved Health Outcomes Activated Patient/Client Activated-Informed Provider/ Support TEAM EXCELLENT CARE – Every Patient, EVERY time Timely access to provider team Clear Communication Patient Priorities Data/evidence available to clinician and patient – Individual and panel management Follow up Constant patient-centered system improvement Patient-Centered, Provider Supported CARE Health Literacy – A piece of the pie Health Literacy – A piece of the pie Improving health outcomes in All Populations Impact of SOCIETY *Poverty *Education *Social equity Impact of SOCIETY *Poverty *Education *Social equity

23 Customer Satisfaction Cycle time Diabetes – A1cs, BPs CVD – BPs controlled Depression – PHQs completed SM Goals Set Patient Safety - Health Lit/Clear Communication Tobacco Cessation Discussed Community Health Partners: Community Health Partners: Outcomes… in pursuit of the mission

24 Contact Information For more information contact: Linda Johnston Lloyd /