<p>Running head: IMPROVING COMMUNICATION – HEALTH CARE LITERACY 1</p><p>Improving Communication in Relation to Health Care Literacy</p><p>Team Yellow – Tamira Dyers, Susan Koshy, Sandra Mendoza, Christopher Philip</p><p>This paper is submitted in partial fulfillment of the requirements for </p><p>Management of Health Service Organizations – HSM 5003.50</p><p>Texas Woman’s University</p><p>School of Management</p><p>Dr. Patricia Driscoll</p><p>July 9, 2014</p><p>Table of Contents</p><p>Introduction ………………………………………………………………….…….……. Page 3 IMPROVING COMMUNICATION – HEALTH CARE LITERACY 2 Purpose and Justification ………………………………………………………….……. Page 3-4</p><p>Definition of Terms ……………………………………………….…………………….. Page 4-5</p><p>Methodology ……………………………………………………………………...……... Page 5-6</p><p>Review of Literature ……………………………………………………………...…...... Page 6-9</p><p>Field Research …………………………………………………………...………………. Page </p><p>Conclusion ………………………………………………………………..……………… Page</p><p>References …..……………………………………………………………..………...…… Page</p><p>Introduction</p><p>The complexity of the verbiage used in discharge instructions negatively affects the patient’s and caregiver’s ability to understand and comply with a plan of care. Although most IMPROVING COMMUNICATION – HEALTH CARE LITERACY 3 documents and verbiage are developed by third parties outside of the clinical site, healthcare management holds a shared responsibility to ensure its healthcare professionals possess the skills and cultural competence to meet the demands of a low health literacy population. More than 75 million English-speaking adult Americans are rated at a low health literacy level (Agency for</p><p>Healthcare Research and Quality, 2011). This low health literacy rate translates into serious healthcare issues facing America today. Our research will discuss the factors affecting health literacy and will also reveal how managers can implement changes to the discharge process to improve patient health literacy.</p><p>Purpose </p><p>The purpose of our research proposal is to make a simple and clear discharge instruction that can be understood easily by anyone with an education level as low as a 6th grade education level. Our goal is to manage health care literacy during patient discharge by improving communication. </p><p>Justification </p><p>Patients are often sent home with complex discharge instructions that are difficult to follow and can become overwhelming (McBride & Andrews, 2013). Discharge is a critical, high risk time for patients and family members as they are assuming care which is often new and unfamiliar (Girard, 2013). On discharge, a person loses the title of patient and all the professional support associated with it. (McBride & Andrews, 2013). The former patient is expected to have the knowledge and confidence to assume self-care and monitoring any new or changed health status on discharge (McBride & Andrews, 2013). It is estimated that one in five patients experiences complications due to adverse events after discharge, resulting in possibly preventable use of health care services such as emergency room visits, primary care and re IMPROVING COMMUNICATION – HEALTH CARE LITERACY 4 hospitalization (McBride & Andrews, 2013). One of the reasons is that at the time of discharge, nurses and other health care professionals have an inability to accurately assess a patient’s comprehension of discharge teaching (McBride & Andrews, 2013). Healthcare professional often believe that they have provided enough information when, in reality, they have failed to effectively communicate with the patients (McBride & Andrews, 2013). Proper patient education and coordination of care is very important as it promotes self- care, adherence and recovery, while minimizing adverse events (Girard, 2013). Discharging patients home with incomplete understanding of self- care instructions put them at high risk for adverse events (Engel et al., </p><p>2012). One study showed that more than 75 % of patients presenting to the emergency department demonstrated knowledge deficits in one domain of their discharge information and more than 50 % had deficits in two domains (Engel et al., 2012). Safe, high- quality patient care requires effective communication, and there is evidence from the inpatient setting that patients who are better prepared for transitions in their care experience improvements in morbidity and resource utilization (Chugh, Williams, Gigsby, & Coleman, 2009). One of the consequences of not providing proper discharge instructions is lack of medication compliance with patient as they believe that the medication is unnecessary or ineffective resulting in re hospitalizations (McBride</p><p>& Andrews, 2013). High quality counselling consisting of individualized teaching sessions provided by a health care professional prior to discharge has been associated with an increased rate of observance of discharge plans by patients, a reduction in mortality, hospitalizations and health care costs(McBride & Andrews, 2013).</p><p>Definition of Terms IMPROVING COMMUNICATION – HEALTH CARE LITERACY 5 Health Literacy – Health literacy is the ability of people to successfully obtain, process and understand health information and services in order to make sound health decisions (U.S. </p><p>Department of Health and Human Services, 2000).</p><p>Cultural competence – the ability of healthcare systems and professionals to recognize the cultural beliefs, values, traditions and language and healthcare preferences of a diverse patient population and to apply the knowledge to improve the delivery and outcome of healthcare (U.S. </p><p>Department of Health and Human Services, 2001).</p><p>Healthcare Numeracy skills – the ability to understand and use numbers and apply them to healthcare topics such as calculating low blood sugar levels, copays, and measuring medications </p><p>(Peters et al., 2014).</p><p>Discharge Summary- set of instructions given to patients at time of discharge. The summary often includes a list of prescriptions, diet and activity restrictions and follow up care details.</p><p>Teach-back method – the healthcare professional tells the patient the plan of care instructions or provides information such as diagnoses, test results or prognoses then asks the patient to repeat what they heard.</p><p>Healthcare professional – anyone who is part of a healthcare organization responsible for patient care including but not limited to managed care organizations, board members and healthcare practitioners.</p><p>Continuing Medical Education (CME) - training and education required to maintain a license to practice medicine. </p><p>Preventive healthcare – healthcare focused on preventing illness and injury before conditions require treatment or become chronic.</p><p>Methodology IMPROVING COMMUNICATION – HEALTH CARE LITERACY 6 1. To complete our study we have collected discharge instructions from four different medical </p><p> facilities throughout the Dallas- Fort Worth metroplex. The data was collected from the </p><p>Veterans Affairs Hospital in North Texas Dallas, Baylor Hospital, St. Paul Hospital and </p><p>Parkland Hospital. </p><p>2. Interviews were also conducted with the patient education departments to determine the </p><p> criterion that was used to put together the final discharge information for patients and to </p><p> determine the actual grade level the discharge instructions were written on. From the </p><p> information gathered from the patient education department we were able to generate a set of</p><p> standard questions that was used to interview the actual discharge nurses and coordinators to </p><p> determine if the literature was effective. </p><p>3. We have also researched online to get a general overview of the effectiveness of other </p><p> medical facilities discharge process as well. </p><p>4. After collecting the discharge information from the different medical facilities and doing </p><p> thorough internet research we were able to compare and contrast the data to determine the </p><p> effectiveness of the literature provided during each medical facilities discharge and to </p><p> determine methods for improvement.</p><p>Review of Literature</p><p>According to the Agency for Healthcare Research and Quality (AHRQ), in 2007, only one in ten people had the literacy skills to manage their health (Dlugacz, 2009). Health care providers must effectively communicate healthcare literature, such as discharge summaries, to patients in a rudimentary way in order for patients to follow instructions properly. Most patients can recollect times when they are presented with bundles of paperwork with a list of medication in illegible hand writing. When providing patients with perioperative care instructions, for IMPROVING COMMUNICATION – HEALTH CARE LITERACY 7 example, nurses often must deal with orders written in illegible handwriting, orders that are confusing in nature, or orders that fail to provide necessary information (Ortoleva, 2010). If this information is confusing to nurses, one could only imagine how complex it would be for a patient with limited healthcare knowledge or low literacy. Patients often ask relatives and others for help in interpreting notes or instructions which can cause even further confusion. The problem of illiteracy in America has cost billions of dollars, due to higher health care costs which is a result of poorly managed health, ineffective health care and higher rates of hospitalization and readmissions (Baker et al., 1997). </p><p>There are several problems with the way health care literature is currently written. The patient may simply find it hard to read the discharge instructions. The discharge instruction sheets need to have large print for the patient to read and should include all information that is pertinent and useful (Ortoleva, 2010). Once the instructions are clear and legible, patients must become familiar with their illness, the names of their medications, dosing schedule, and side effects of their medications (Makaryus & Friedman 2005). </p><p>There are several effective tools that are used to measure patients’ health literacy. Many of the tools include brief questionnaires and assessments given to patients in a way that does not embarrass or shame them in any way. During a congress sponsored by the Association for </p><p>Academic Surgery and the Society of University Surgeons, Dr. Lorraine S. Wallace, Ph.D. stated there are three brief screening questions that allow physicians to spot patients lacking the literacy skills necessary to understand and act upon health care information (Jancin, 2007). These questions include the following: How often do you have someone (like a family member, friend, or hospital worker) help you read hospital material? How confident are you filling out medical forms by yourself? How often do you have problems learning about your medical condition IMPROVING COMMUNICATION – HEALTH CARE LITERACY 8 because of difficulty understanding written information (Jancin, 2007)? Some groups utilized multimedia and animation to facilitate health literacy to different ethnic groups. George et al. discovered that an animated video with ethnically represented characters was an effective tool in promoting better understanding of research consent and discharge instructions (George et al., </p><p>2013). Laura Nimmon, a researcher from the University of Victoria, BC, showed that encouraging immigrant ESL-speaking women to create photo-novels with characters and a script allowed the women to get involved in their nutrition treatment plans (Nimmon, 2007). One woman noted how “you don’t need English to understand it, you just have to point at the picture and look at it (Nimmon, 2007).”</p><p>There are other health literacy tools such as the Rapid Estimate of Adult Literacy in </p><p>Medicine (REALM) which consists of 125 word recognitions and is used to identify persons with limited literacy skills and provide an estimated reading level (Heinrich, 2012). The Test of </p><p>Functional Health Literacy in Adults (TOFHLA) examines a person’s ability to read a paragraph related to medical information that contains numbers (Heinrich, 2012). The TOFHLA, which is available in Spanish and English evaluates a person’s ability to actually use numbers and reading level (Heinrich, 2012). The Medical Term Recognition Test (METER) takes about 2 minutes and requires patients to indicate if they recognize selected medical terms (Heinrich, 2012). Deborah </p><p>Chinn and Catherine McCarthy from the Florence Nightingale School of Nursing and Midwifery at King’s College London and Tower Hamlet Community Health Services in London, respectively, developed the All Aspects of Health Literacy Scale (AAHLS). They reported that their test was not as long as the 22-minute TOFHLA test and provided a way to not only assess patient learning but also promote community health (Chinn & McCarthy, 2013). Lee et al. developed the Short Assessment of Health Literacy for Spanish-speaking adults (SAHLSA) IMPROVING COMMUNICATION – HEALTH CARE LITERACY 9 based on the design of the REALM. In addition to the word recognition test that is used in the </p><p>REALM, the SAHLSA also utilizes a comprehension test using multiple-choice questions, which evaluates the subject’s comprehension of medical terms commonly used in clinical and public health settings (Lee et al., 2006). Furthermore, the test only takes about 3-6 minutes and requires very little training in order to administer (Lee et al., 2006).</p><p>Besides health care literature, in terms of health care communication, the quality and warmth of communication between the physician and patient correlate with patient satisfaction, compliance, and knowledge of the diagnoses and treatment plan, as well as the desire for a quick recovery (Makaryus & Friedman, 2005). Furthermore communication involves many aspects including language (speaking to the patient in terms he or she can understand), practicality </p><p>(giving the patient a regimen that he or she can follow without much disruption to daily life), and time (spending a reasonable amount of time counseling the patient and ensuring that he or she actually comprehends the instructions) (Makaryus & Friedman, 2005). IMPROVING COMMUNICATION – HEALTH CARE LITERACY 10</p><p>References</p><p>Agency for Healthcare Research and Quality. (2011, March). Retrieved from U.S. Department </p><p> of Health and Human Services: http://ahrq.gov/news/newsroom/pressreleases/2011/ </p><p> lowhlit.html</p><p>Baker, D. W., Parker, R. M., Williams, M. V., Clark, W. S., Nurss, J. (1997). The Relationship </p><p> of Patient Reading Ability to Self-Reported Health and Use of Health Services. American</p><p>Journal of Public Health, 87(6), 1027-1030. doi: 10.2105/AJPH.87.6.1027 </p><p>Chinn, D., McCarthy, C. (2013). All Aspects of Health Literacy Scale (AAHLS): Developing a </p><p> tool to measure functional, communicative and critical health literacy in primary </p><p> healthcare settings. Patient Educational and Counseling, 90(2), 247-253. doi: </p><p>10.1016/j.pec.2012.10.019</p><p>Chugh, A., Williams, M., Gigsby, J., & Coleman, E. (2009). Better transitions: improving </p><p> comprehension of discharge instructions. Frontiers of health services management, 25, </p><p>11-32.</p><p>Dlugacz, Y. D. (2009). Focus on the Patient. In Y. D. Dlugacz (Ed.). Value-Based Health Care: </p><p>Linking Finance and Quality (pp. 41-68). San Francisco, CA: Jossey-Bass. </p><p>Engel, K. G., Buckley, B. A., Forth, V. E., McCarthy, D. M., Ellison, E. P., Schmidt, M. J., & </p><p>Adams, J. G. (2012). Patient understanding of emergency department discharge </p><p> instructions: Where are knowledge deficits greatest? Academic Emergency Medicine, </p><p>1035-1044.</p><p>George, S. G., Moran, E., Duran, N., Jenders, R. A. (2013). Using Animation as an Information IMPROVING COMMUNICATION – HEALTH CARE LITERACY 11 Tool to Advance Health Research Literacy among Minority Participants. AMIA Annual </p><p>Symposium Proceedings, 2013(Nov. 16), 475-484.</p><p>Girard, N. J. (2013). Discharge instructions in the PACU: Who remembers? AORN Journal, 98, </p><p>447-448.</p><p>Heinrich, C. (2012). Health literacy: The sixth vital sign. Journal of the American Academy of </p><p>Nurse Practitioners, 24(4), 218-223. doi: 10.1111/j.1745-7599.2012.00698.x.</p><p>Jancin, B. (2007). Fast screening tool rates patients’ health literacy. Internal Medicine News, </p><p>40(9), 49. doi: 10.1016/S1097-8690(07)70541-3</p><p>Lee, S. D., Bender, D. E., Ruiz, R. E., Cho, Y. I. (2006). Development of an Easy-to-Use </p><p>Spanish Health Literacy Test. Health Service Research, 41(4 Pt 1), 1392-141. doi: </p><p>10.1111/j.1475-6773.2006.00532.x </p><p>Makaryus, A. N., Friedman, E. A. (2005). Patients’ Understanding of Their Treatment Plans and </p><p>Diagnosis at Discharge. Mayo Clinic Proceedings, 80(8), 991-994. doi: http://dx.doi.org/ </p><p>10.4065/80.8.991</p><p>McBride, M., & Andrews, G. J. (2013). The transition from acute care to home: A review of </p><p> issues in discharge teaching and a framework for better practice. Canadian Journal of </p><p>Cardiovascular Nursing, 23, 18-24.</p><p>Nimmon, L. E. (2007). Within the Eyes of the People: Using a Photonovel as a Consciousness-</p><p> raising Health Literacy Tool with ESL-speaking Immigrant Women. Canadian Journal </p><p> of Public Health, 98(4), 337-340.</p><p>Ortoleva, C. (2010). An Approach to Consistent Patient Education. AORN Journal, 92(4), 437-</p><p>444. doi: 10.1016/j.aorn.2010.04.018.</p><p>Peters, E., Meilleur, L., Tompkins, M.K. (2014). Numeracy and the affordable care act: IMPROVING COMMUNICATION – HEALTH CARE LITERACY 12 opportunities and challenges. Retrieved from Institute of Medicine of the National </p><p>Academies: http://www.iom.edu/Reports/2014/Health-Literacy-and-Numeracy.aspx</p><p>U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: </p><p>U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000.</p><p>Introduction. In National Library of Medicine Current Bibliographies in Medicine: </p><p>Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. </p><p>CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health </p><p> and Human Services. </p><p>U.S. Department of Health and Human Services. 2001. National Standards for Culturally and </p><p>Linguistically Appropriate Services in Health Care. Washington, DC: Office of Minority </p><p>Health.</p>