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					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




                                                      1
    America’s 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.

   HRSA’s 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.


                                                                             2
 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.




                                                                       3
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 Nation’s 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.
                                                                        4
          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”.



                                      5
Health Literacy is a Common
Denominator
   Secretary’s 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
                                                                6
          affected by health disparities
Joint Commission: “What did the Doctor
Say?: Improving Health Literacy to
Protect Patient Safety.”


“Effective communication is a cornerstone of patient
  safety,” says Dennis S. O’Leary, 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
  harm’s way.”



                                                         7
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 Mexico
       Laurie Francis- Community Health Partners
        South Central Montana
                                                        8
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.

                                                            9
              HRSA’s 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- 2007-01: Cultural and Linguistic Competence, page one

                                                                      10
Unified Health Communication
Training Course: Main Screen




                               11
Course Information
   Web-based, interactive course via HRSA Internet:
     http://www.hrsa.gov/healthliteracy/training.htm


   HRSA provides the link to TRAIN for registration and the course
    content.

   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.
                                                                          12
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



                                               13
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
                                                  14
   Presbyterian Medical Services (PMS)
   New Mexico


    Meeting the
 community needs
       of the
multi-cultural people
 of the Southwest




                                         15
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          PMS Staff Demographics
 Asian/Pacific Islander 0%       Asian/Pacific Islander <1%
Black/African American 1%       Black/African American 1.2%
   Native American 16%            Native American 12.6%
   Hispanic/Latino 42%             Hispanic/Latino 37.1%
        White 41%                       White 46.7%
         Other 1%                        Other 1.9%

                                 Marilyn Disher                                16
                                                              Marilyn Disher
Promising Practices

   Project ECHO (“distance learning”)
    [Extension for Community Healthcare Outcomes]

   CLAS Project
    [Culturally and Linguistically Appropriate Services]

   Standardized forms



                                                                            17
                                                           Marilyn Disher
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 CEU’s 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


                                                                        18
                                                       Marilyn Disher
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

                                                     19
Community Health Partners
South Central Montana

                    Enhancing Community Health
                          and Well-Being




                      Laurie Francis             20
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

                                   Laurie Francis                     21
                  Health Literacy – A piece of the pie
           Improving health outcomes in All Populations


                                EXCELLENT CARE – Every Patient, EVERY time
                                         •Timely access to provider team
                                              •Clear Communication
    Activated-Informed
                                                •Patient Priorities
       Provider/                •Data/evidence available to clinician and patient –
     Support TEAM                       Individual and panel management
                                                    •Follow up
                                 •Constant patient-centered system improvement




Patient-Centered,
     Provider                                                       Improved
    Supported                 Activated                              Health
      CARE                  Patient/Client                          Outcomes

                                                                                   Impact of
                                                                                   SOCIETY
                                                                                   *Poverty
                                                                                          22
                                                                                  *Education
                                                                                 *Social equity
    Community Health Partners:
         Outcomes…
        in pursuit of the mission


   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

                                        23
Contact Information
   For more information contact:
           Linda Johnston Lloyd
       ljohnston-lloyd@hrsa.gov
    www.hrsa.gov/healthliteracy/


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