The need is growing for case managers to improve patients’ health literacy, their ability to understand what they’re being told and what they need to do to care for themselves.

The Institute of Medicine reports that an estimated 77 million U.S. adults have low health literacy, more than a third of the U.S. adult population. Millions more lack the skills necessary to make clear, informed decisions about their own health care.

That deficit, according to the American Medical Association, is "a stronger predictor of a person's health than age, income, employment status, education level and race."

In May, the U.S. Department of Health and Human Services added health-literacy questions to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey as part of its quality-improvement efforts.

Patient Comprehension Is Key to Good Care Transitions

Case managers should be focused on health literacy. Many patients may experience cognitive challenges because of a medical illness, testing and treatment, functional impairments (either temporary or ongoing) or stress from being in a different environment. That, on top of literacy issues, may lead to a situation in which patients may have limited ability to express or understand their treatment preferences or communicate with multiple providers (e.g., primary-care physicians, specialists, pharmacists). And that may result in readmissions.

As an example, a discharge plan that recommends home health for a patient with a total hip replacement could have consequences if the patient doesn’t understand services provided. The discharging physician could have agreed that the patient is functionally able to receive necessary therapy at home, but do the patient and family really understand what this means? If the patient and family don’t understand what a home-health agency can and cannot provide, there’s a good chance the patient will end up back in the hospital.

Practical Steps to Address Health Literacy

Case managers can assist with health literacy in several ways. To ensure patient comprehension that promotes positive outcomes, staff should:

• Emphasize two-way communication. It’s not enough for staff to use educational materials below the fifth-grade level with a large font and liberal spacing for readability, and then automatically send patients on to the next level of care. Making sure the patient understands next steps will increase the chances of good placement and reduce the risk of readmission. Adopt a teach-back approach: Have patients demonstrate how they take their medications. Have them explain how often they take medications and why. Asking for these answers provides a good indication of their health-literacy level.
   
• Make cognitive testing part of admissions. When patients are admitted, assess their ability to understand instructions. If there is an indication that the patient might not understand the goals for continuity of care, it’s essential to get a family member involved with the discharge plan and its implications. Hospital staff can be diligent about providing patient choice, but these efforts are meaningless if the patient doesn’t understand the consequences of those choices.
   
• Adapt to patient needs. If a patient does not complete a form or takes a long time to fill it out, it could mean he didn’t understand some questions. Because a patient may be embarrassed by this, offer assistance to complete the paperwork in a private space. Similarly, speak slowly and enunciate. Patients with little health literacy may be intimidated by a fast-talking clinician. Pause to make sure your patient understands what you’re saying. Focus on key points instead of giving the patient everything at once. Patients will likely retain more information from two short conversations than one long one.

---

Jackie Birmingham, RN, MS, is vice president, emeritus, of clinical leadership at Curaspan Health Group. This article reprinted with permission. View the original article on the Curaspan website.