A QI initiative for bridging the health literacy gap by Educating internal medicine residents at a community hospital

Abstract

Introduction: Only 12% of Americans have proficient health literacy (HL). Patients hide this fact from others including physicians. This quality improvement (QI) project was developed to compare internal medicine (IM) resident physicians’ (RPs) ability to accurately predict patients with low HL and to improve IM-RPs’ understanding of low HL and its impact on patients.Aim statement: Over six-months, our aim was to increase the IM residents’ HL-knowledge by 30% as measured by an HL-Knowledge-Based-Survey.Methods: After IRB exemption, patients visiting the residency-clinic within a two-week period were screened for low HL with the REALM-R, a validated tool. Post-visit, IM-RPs were asked to predict their patients’ HL. A comparison of predicted-HL and measured-HL was made. IM-RPs were emailed an HL-Knowledge-Based-Survey (pre-education and post-education) to measure their background knowledge of HL. Education included HL-workshop, pre-clinic conference and lectures. Pre-education and post-education scores were compared.Results: HL-RPs’ prediction and patients’ REALM-R results were completed by 108 RP-patient pairs. IM-RPs correctly identified 5 of 40 patients who were at risk for low HL (sensitivity = 12.5%). They correctly identified 97.1% of 68 who were not at risk (specificity = 97.1%). Our residents’ knowledge pre-education and post-education did not improve – 58% (n = 18) vs 62% (n = 10).Conclusion: Our QI result verified that IM-RPs overestimate patients’ HL and do not understand the magnitude or consequences of low HL nor techniques to improve such patients’ understanding. This suggests an area for residency curricular development in order to improve patients’ ability to navigate the healthcare system successfully.

Screening Health-Related Social Needs in Hospitals: A Systematic Review of Health Care Professional and Patient Perspectives

“… 19 The other study reported that resident physicians overestimate patients' health literacy and may underestimate the influence of low health literacy on patients' understanding during clinical interactions. 20 …”

Health literacy strategies: a Caribbean approach

“…16,31,32 Research shows that one of the main deficiencies in health literacy is the lack of awareness among physicians about their role in improving health literacy in their patients. 33,34,20 In recent years, the role of the physician in improving health literacy among patients has received some attention in the literature. Ousseine et al 35 explored the necessary factors in order to achieve shared decision-making between physicians and patients.…”

“…37 This mistake typically leads to physicians over-estimating the health literacy level of their patients especially that of minority patients, and as such either do not use health literacy strategies with them or provide patients' education that is incongruent with their needs. 38,39,34 In an effort to eliminate this mistake, Hedelund-Lausen et al 39 suggested that practitioners should not only identify patients with low health literacy skills but help to build their levels of health literacy in recognition of the consequences of having poor health literacy.…”