Implementing Routine Health Literacy Assessment in Hospital and Primary Care Patients

Abstract

Background Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs, compared to those with adequate health literacy skills. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a brief health literacy screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center. Methods Changes were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Support was gained from nursing leadership, education and training was provided, a documentation change was rolled out, feedback was obtained, and uptake of the new health literacy screening items was monitored. Results Between November 2010 and April 2012, there were 55,611 adult inpatient admissions, and from November 2010 to September 2011, 23,186 adult patients made 39,595 clinic visits to the three primary care practices. The completion (uptake) rate in the hospital for November 2010 through April 2012 was 91.8%. For outpatient clinics, the completion rate between November 2010 and October 2011 was 66.6%. Conclusions Although challenges exist, it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations.

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial

“…Screening health literacy levels as part of a standard patient intake evaluation would facilitate this stratification. 28 Finally, to have a robust effect on post-discharge health care utilization, medication safety interventions may need to be part of multifactorial interventions that focus on several domains of transitional care.…”

Understanding health talk in an urban Aboriginal and Torres Strait Islander primary healthcare service: a cross-sectional study

“…The Brief Health Literacy Screen (BHLS) section included three questions that obtained information on the frequency of requiring assistance with reading health materials; experiencing problems learning about their medical condition because of difficulty reading health materials; and confidence in completing health forms. The BHLS is easily administered in clinical settings (Chew et al 2008;Cawthon et al 2014;Faruqi et al 2015), with studies supporting its internal consistency, predictive ability and concurrent validity (Chew et al 2008;Wallston et al 2014). The third section comprised nine questions from the 'Communication with Provider' CAHPS (Health literacy program) survey tool, a component of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program.…”

Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes

“…Scores for this measure can range from 3 to 15, with higher scores representing higher health literacy. The BHLS was administered orally by nursing staff during any admission to Vanderbilt University Hospital or at any visit to Vanderbilt Internal Medicine Primary Care Clinics as a part of the standard intake process beginning in 2011 [31] BHLS scores were assessed in this study as the average value of within-individual scores for each patient with ≥ 1 available BHLS score. We have validated this measure as a reliable indicator of health literacy in inpatient and outpatient settings at Vanderbilt University [30, 31].…”

“…The BHLS was administered orally by nursing staff during any admission to Vanderbilt University Hospital or at any visit to Vanderbilt Internal Medicine Primary Care Clinics as a part of the standard intake process beginning in 2011 [31] BHLS scores were assessed in this study as the average value of within-individual scores for each patient with ≥ 1 available BHLS score. We have validated this measure as a reliable indicator of health literacy in inpatient and outpatient settings at Vanderbilt University [30, 31]. There is also evidence that BHLS scores are stable in adulthood, allowing us to explore the relationship between a single average score per patient and the outcome during the entire study period [30–34].…”