1. LAWRENCE COUNTY COMMUNITY DIABETES TEAM

2. “Health Literacy can save lives, save money, and improve the health and wellbeing of Americans. We must bridge the gap between what health professional know and what what patients understand.” Surgeon General Richard H. Carmona, M.D., M.P.H., F.A.C.S

3. Why Health Literacy? HL is part of the Patient Protection and Affordable Care Act. We have a National Plan to Improve Health Literacy, based on the principles that (1) everyone has the right to health information that helps them make informed decisions and (2) health services should be delivered in ways that are understandable and beneficial to health, longevity, and quality of life.

4. WHY HEALTH LITERACY? Nearly 9 out of 10 adults have difficulty using health information received at healthcare facilities. People with limited HL are likely to skip necessary medical tests, end up in the emergency room, and have a hard time managing chronic diseases like diabetes or high blood pressure. Poor HL cost the U.S. economy as much as $238 billion annually.

5. THE HEALTH LITERACY PROJECT – ASSESS, CONNECT, EMPOWER OUR TEAM’S STEPS TO IMPROVEMENT Poor health outcomes associated with limited HL were identified. Coordinated this HL continuing education and performance improvement project with Southern KY Area Health Education Center. Recruited participants: clinic staff from Lawrence Co. Health Dept., a family practice physician and an emergency room physician.

6. STEPS TO IMPROVEMENT Participants conducted HL assessments of their organizations. Based on identified gaps intervention tools were selected form the HL Universal Precautions Toolkit which was developed by the Agency for Healthcare Research and Quality (AHRQ).

8. Our Top “needs improvement”: Encouraging questions Teach Back Welcoming patients (e.g. signage)

9. ENCOURAGE QUESTIONS? Encourage patients to write down their questions and prioritize them. Suggest that family/caregiver be present for teaching. “What questions do you still have?” “That was a lot of information. What do I need to go over again?” If patient has a lot of questions, help them to prioritize and defer some for future sessions.

10. Ask Me 3 A education program from the National Patient Safety Foundation that encourages patients to ask their health care providers three questions:  What is my main problem?  What do I need to do about it?  Why is it important

11. On the way in…  Be warm, welcoming, and approachable.  Be alert to the possible need for assistance with forms.  Suggest that patients/families write down questions while they are waiting.

12. DURING THE APPOINTMENT… Phrasing is everything! “Do you have any questions?” OR “What questions do you have?”

13. ON THE WAY OUT… “Did we answer all of your questions?” “Did you get all your questions answered?” “ How else might we help you today?”

14. Teach Back is…  Asking patients to repeat in their own words what they need to know or do, in a non-shaming way.  NOT a test of the patient, but of how well we explained a concept.  A chance to check for understanding and, if necessary, re-teach the information.

15. Teach Back - Examples “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?” “What can you tell me about the changes we made to your blood pressure medicines today?” “We’ve gone over a lot of information about things you can do to get more exercise in your day. Can you tell me some of the things you plan to do.”

16. Welcoming Patients  Organization brochure  Waiting rooms  Signs  Identify important locations  Evaluate existing (or non-existing) signage  Simple, consistent, universal wording  Graphics, color coding

18. Results of Follow-Up Assessment Improvement of:  31% Encouraging Questions  38% Teach Back  1% Welcoming Atmosphere

19. No Time to Teach  Book  Blog http://notimetoteach.com/

20. Community Interventions Develop and distribute the “Healthy Living with Diabetes” booklet using resources from www.learningaboutdiabetes.org www.learningaboutdiabetes.org Distribute our brochure: “Health & Fitness Explorer – A Guide to Resources on the Internet.” Currently training Ambassadors for Health and developing a Health Resource Toolkit for their use.

21. Health Literacy in Action Ambassadors for Health: 5 staff members of Pathways Mental Health Agency’s Adult Day Training. Pedometer Walking Program: 20 Pathways members walk around their building, a school track or a church with an indoor track. Monthly Programs: nutrition, blood pressure, diabetes, fitness… along with incentives of water bottles, stretch bands…

22. Some Surprising Results One member had refused all types of physical activity but is now the “cheerleader” of the group. One member actually used the pedometer on his wheelchair and another lady achieved her weight loss goal. Another member with insulin dependent diabetes has had a significant improvement in her blood sugar levels.