Toward Health Equity and Patient-Centeredness Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary (2009) / Chapter Skim
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2 Opportunity at the Intersection of Quality Improvement, Disparities Reduction, and Health Literacy
2 Opportunity at the Intersection of Quality Improvement, Disparities Reduction, and Health Literacy
Pages 5-16
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From page 5... ...
Before exploring the integration of these three concepts, it is worthwhile to explore each component separately. More specifically, Isham spoke about the following issues: • The state of quality improvement research, variations in quality of care, and the rate of improvement in the United States; • Health disparities in the United States, progress in address ing health disparities, and health care system strategies to address disparities; • Health literacy and "the perfect storm" of declining literacy levels, an increasingly diverse population, and a large level of expected job growth in knowledge-intensive work environ ments; and • Ideas for improving disparities in health care and health lit eracy, including the use of a medical home model, changes in the structure of the care delivery system, and using evidence based medical practices.
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From page 6... ...
. It is not enough to change the payment and regulatory environment; health care organizations and teams providing care must be sup Of the infant mortality rates reported for 32 developed countries, the United States had higher infant mortality than 30 other countries, ranking above only the country of Latvia (Nordquist, 2006)
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From page 7... ...
It is not enough to focus on quality; disparities must be addressed as well. This is an important consideration, as health care outcomes show significant disparity by race, ethnicity, and education level.
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From page 8... ...
Other recommendations include the creation and maintenance of payment systems to ensure an adequate supply of services to racial and ethnic minority patients, enhancing communication and trust between providers and patients via the provision of incentives for practices that reduce barriers to highquality health care and encourage the adoption of evidence-based practices, provision of greater support of interpreter services and community health workers, and the implementation of multidisciplinary teams for the provision of care. Despite these IOM recommendations, a more recent report, the 2007 National Healthcare Disparities Report (NHDR)
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From page 9... ...
Additionally, health care providers need to have strong communication and assessment skills as do the media, the marketplace, and government agencies -- to provide health information in a manner appropriate to the intended audience. The complexity of the health care system and the way patients experience it contribute to the difficulty of being health literate.
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From page 10... ...
10 TABLE 2-1 Largest Disparities in Health Care Quality for Selected Groups: 2005 versus 2007 NHDRa 2005 NHDR 2007 NHDR Group Measure Relative rate Measure Relative rate Black New AIDS cases per 100,000 10.4 New AIDS cases per 100,000 10.0 population age 13 and over population age 13 and over Hospital admissions for pediatric 4.0 Hospital admissions for pediatric 3.8 asthma per 100,000 population ages asthma per 100,000 population ages 2–17 2–17 Percent of patients who left the 1.9 Hospital admissions for lower 3.8 emergency department without being extremity amputations in patients seen with diabetes per 100,000 population Asian Persons age 18 or older with 1.6 Composite: Adults who reported 1.6 serious mental illness who did not poor communication with health receive mental health treatment or providers counseling in the past year Adults who can sometimes or never 1.6 Long-stay nursing home residents 1.5 get care for illness or injury as soon who were physically restrained as wanted Adults age 65 and over who did 1.5 Adults age 65 and over who did 1.5 not ever receive pneumococcal not ever receive pneumococcal vaccination vaccination AI/ANb Women not receiving prenatal care in 2.1 Women not receiving prenatal care 2.1 the first trimester in the first trimester
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From page 11... ...
Composite: Adults who reported 1.8 Composite: Adults who reported 1.8 poor communication with health poor communication with health providers providers Children ages 2–17 with no advice 1.3 Women age 40 and over who 1.8 about physical activity reported they did not have a mammogram within the past 2 years Hispanic New AIDS cases per 100,000 3.7 New AIDS cases per 100,000 3.5 population age 13 and over population age 13 and over Adults who can sometimes or never 2.0 Hospital admissions for lower- 2.9 get care for illness or injury as soon extremity amputations in patients as wanted with diabetes per 100,000 population Composite: Children whose parents 1.8 Women not receiving prenatal care 2.0 reported poor communication with in the first trimester their health providers Poor Composite: Children whose parents 3.3 Composite: Children whose parents 3.0 reported poor communication with reported poor communication with their health providers their health providers Adults who can sometimes or never 2.3 Adults who can sometimes or never 2.4 get care for illness or injury as soon get care for illness or injury as soon as wanted as wanted Children ages 2–17 who did not have 2.0 Women age 40 and over who 2.1 a dental visit reported they did not have a mammogram within the past 2 years aNHDR = National Healthcare Disparities Report. bAI/AN = American Indian/Alaska Native.
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From page 12... ...
We lack the measurement tools to assess patient literacy in patient populations served by operating health care systems. Quality measures for improving health literacy are lacking.
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From page 13... ...
(2008) suggest that the following needs to occur: Use data to identify the most vulnerable populations; tailor our interventions to fit high-risk populations; simplify materials so they are tailored to the individuals being served; and, in the longer term, help build health literacy through education systems so patients can better act on their own behalf in the health care setting.
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From page 14... ...
Rather, people are left to make health decisions on a daily basis on their own behalf. This compounds the difficulty of increasing health literacy, and, in turn, remains a significant barrier to improving health care quality.
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From page 15... ...
However, there has been very little discussion in health care reform about how to provide the kinds of infrastructure and support to enable health care organizations to improve quality and deal with the challenges of complex interactions between quality improvement, health disparities, and health literacy. Providing equitable, patient-centered, high-quality care is not only an issue of an individual clinician dealing with a patient.
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From page 16... ...
A robust research agenda focusing on health literacy and health disparities is critical to ensure that patient-centered care becomes incorporated as a critical underpinning in all quality improvement efforts. Shared decision-making skills in the health care delivery system are critical, as is the creation and implementation of effective interventions by trained teams with appropriate skills.
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