AMA Health Literacy Policies and Programs

1. AMA Health Literacy Policies and Programs June 10, 2005 National Coalition for Literacy Policy Forum Washington, DC December 5, 2007

2. Peter W Carmel, MD, D Med Sci • Professor and Chairman • Department of Neurological Surgery • The New Jersey Medical School • Newark, New Jersey

3. The New Jersey Medical School

4. Early efforts 1995 - JAMA publishes study: patients with low literacy have poorer health outcomes, with longer and more frequent hospitalizations* 1997 – AMA Council on Scientific Affairs – convenes national panel of experts – reports to AMA House 1998 – AMA creates new policy on health literacy, first national medical organization to do so * Funded by R.W. Johnson Foundation

5. AMA Health Literacy Policy (H 160.931) Limited patient literacy is a barrier to care Encourages development of appropriate patient education materials Work to make the healthcare community aware of large number of patients with poor understanding of health care information Develop programs for med students, residents, and physicians to better communicate Encourages compensation for patient education Asks DOE to include questions on health literacy in National Adult Literacy Survey Encourages federal and private funds for health literacy research HOD - 1998

6. The Health Literacy Program – (AMA Foundation) Foundation launches program, funded by a series of grants (Generous grant from Pfizer) Creation (with partners) of the Health Literacy video/kit Over 28,000 kits distributed Train-the-Trainer curriculum; over 20,000 trained Grant program for students, residents, practicing physicians, community groups Website, newsletter, listserv, & PR

7. Increased awareness • Evaluated the first two years of program by surveying physicians and found: • Approximately 2/3 of physicians who responded were not aware of health literacy • However, after learning about health literacy: 93% ranked it as important to patient care 65% reported making changes in their clinical practice • Approximately 14% learned about the issue from AMA Foundation

8. Changed behavior • Mailed survey to 344 participants (2004) • 126 returned (36.6%) • 70% report having made changes in their practices • 71% felt they had increased the quality of care they provided

9. Reported Practice Changes After Training: 2004

10. Degree of Practice Change Reported: 2004

11. Practice Change Reported: 2004 Three most useful steps: The teach-back method Avoiding technical jargon Speaking more slowly Most felt that they had increased the quality of care they provided

12. Second phase – Shift of focus from individual physician to system-wide effect First health literacy textbook: “Understanding Health Literacy: Implications for Medicine and Public Health” Eds. Schwartzberg JG, Van Geest JB, Wang CC We will publish results from NAALreport Health literacy as a patient-safety issue Conference Monograph Tip cards

14. AMA Foundation Patient Safety and Health Literacy Initiative • Why should clinicians get involved and be willing to change their practices? • Must believe there is a serious problem and that change would help their patients or their practices. • Changes suggested must be compatible with values, beliefs and current practices. • Changes must be simple, easily adaptable.

15. Why are we at risk? • Unrealistic expectations of patients may lead to unintended medical errors • Increased malpractice risk • Unrealistic expectations of effective staff- staff communication may lead to medical errors • System failures, example: need for medication reconciliation.

16. AMA Foundation Patient Safety and Health Literacy Initiative • How can we change the current environment? • Recognize or anticipate potential patient harm or risk. • Mitigate or avoid risk through system change. • Develop patient-centric reactions to exposure to risk.

17. The Continuum of Confusion“Now, go home and manage your care.”

18. AMA Foundation Patient Safety and Health Literacy Initiative • Identify the potential harm and risks • Walk through the setting to note each communication interaction/opportunity for misunderstanding • Patient’s “Continuum of Confusion”

19. Module 1 Improving Communication to Improve Patient Safety. • Clinician-Patient Communication • Patient Education Materials • Disease Management Programs • Administration/Environment • /System Change National outreach, NPSF, “ask me three”

20. SOAP-UP • The SOAP -UP Note • S – Subjective • O – Objective • A – Assessment • P – Plan • U – Use the “teach back” to check for • understanding • P – Plan for health literacy help

21. Vision • Healthcare providers and their staffs consider health literacy a crucial force that improves patient safety. • Health literacy concepts are widely accepted in mainstream clinical practice.

22. Our Mission: • To Help Physicians Help Their • Patients Understand

27. HEALING THE SYSTEM The AMA Plan to rescue U.S. Medicine