1. “Do You Understand?” Review and Practice of Teachback
CMMI Learning Collaborative
November 19, 2013

2. What Would You Guess?
How much of what we say to patients is truly understood?
How do we know how much is understood?

3. Are You Hearing Me?
There is considerable evidence that many patients leave medical encounters with a poor understanding of their disease and the recommended treatment.
Some studies say that as much as 50-60% of information we share with patients is simply lost. Some say even more.
J Am Board Fam Med January-February 2008 vol. 21 no. 1 24-30

4. What is Health Literacy?
The ability to get, process, and understand health information to make informed decisions about their health care.
May involve seeking care, taking medications correctly, and following prescribed treatments (incl follow up appts), requiring that people understand how to access and apply health information
According to a national survey, over one-third of the adult population has limited health literacy, meaning that they have basic or below basic health literacy levels.
Limited health literacy is associated with medication errors, increased health care costs, and inadequate knowledge and care for chronic health conditions.
(AHRQ Health Literacy Precautions Kit)

5. How Can You Tell What a Pt is Taking Away?

6. Health Literacy Video- Seeing things through their eyes

7. One Size Fits All? Everyone benefits from clear information.
Many patients are at risk of misunderstanding, but it is hard to identify them (education? Well spoken? Say “yep, I got it!”, white collar/healthcare jobs?)
Assume everyone may have difficulty understanding
Adapted from: Reducing the Risk by Designing a Safer, Shame-Free Health
Care Environment. AMA, 2007

8. What Is Teachback?
A way to make sure we have explained information clearly (not a test/quiz).
Asking a patient (or family member) to explain in their own words what they need to know or do, in a caring way.
A way to check for understanding and, if needed, re-explain and check again.
A research-based health literacy intervention that improves patient-provider communication and patient health outcomes.
Health Literacy Iowa, 2013

9. Tips for Talking, and Listening
Slow down. We often just talk too fast.
Use plain, nonmedical language. Explain things to patients like you would explain them to your grandmother. 
Show or draw pictures. Visual images can improve the patient’s recall of ideas.
Use a caring tone/posture.

10. Tips for Talking, and Listening
Limit the amount of information provided—and repeat. Chunk and check!
Create a shame-free environment: Encourage questions. Enlist the aid of others (patient’s family or friends) to promote understanding.
Close the loop. Confirm that patients understand by asking them to repeat back your instructions.

11. Teachback Techniques
Ask the patient to explain back, using their own words.
Use open-ended questions (not yes/no).
Emphasize that the responsibility to explain clearly is on you.
If the patient is not able to teach back correctly, explain again and re-check.

12. Teachback/Closing the Loop Resources
Closing the Loop Video Demo
More resources:
Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. Arch Intern Med. 2003 Jan 13;163(1):83-90.