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Health Literacy Interventions: Current and Future Exemplars Michael - - PowerPoint PPT Presentation
Health Literacy Interventions: Current and Future Exemplars Michael - - PowerPoint PPT Presentation
Health Literacy Interventions: Current and Future Exemplars Michael Paasche-Orlow, MD MA MPH Professor of Medicine General Internal Medicine Boston University School of Medicine 3 December 2018 Health Literacy Hub - WSLHD Consumer Enablement
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Water Sunlight Protection Funding Marketing Executive Sponsorship + Champions + Program Management
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Federal Funders
NCI NHLBI NIMHD NIAAA NIDA NICHD NIDCR AHRQ NIMH NHGRI CDC DOD HRSA PCORI NIDDK NIBIB NLM
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https: / / health.gov/ communication/ hlactionplan/ pdf/ Health_Literacy_Action_Plan.pdf
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National Action Plan
Two core principles:
- All people have the right to health information that helps them
make informed decisions
- Health services should be delivered in ways that are easy to
understand and that improve health, longevity, and quality of life It will take everyone working together in a linked and coordinated manner to improve access to accurate and actionable health information and usable health services. By focusing on health literacy issues and working together, we can improve the accessibility, quality, and safety of health care; reduce costs; and improve the health and quality of life of millions of people.
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Tremendous Attention on Rehospitalization
Efficiency
Allows for the alignment of improving quality and decreasing cost
Plentiful
2006: 39.5 million hospital discharges with costs totaling $329.2 billion!
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RED Checklist
Eleven mutually reinforcing components: Patient education Follow-up appointments Outstanding tests Post-discharge services Medication reconciliation Reconcile dc plan with National Guidelines What to do if problem arises Dc summary to PCP Assess patient understanding Written discharge plan > Telephone Reinforcement Adopted by National Quality Forum as one of 30 "Safe Practices" (SP-15)
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Operationalizing RED
After Hospital Care Plan Discharge Educator Follow-up phone call
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COVER PAGE
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MEDICATION PAGE (1 of 3)
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MEDICATION PAGE (2 of 3)
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MEDICATION PAGE (3 of 3)
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APPOINTMENT PAGE
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APPOINTMENT CALENDAR
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PATIENT ACTIVATION PAGE
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Components of RED Intervention
In Hospital – Nurse Discharge Educator
Interacts with care team: medication reconciliation, appointments, and national guidelines Prepares and teaches After Hospital Care Plan
Post Discharge – Clinical Pharmacist
Calls for follow-up @ 72 hours post-dc Reinforces dc plan and review medications
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Enrollment N=749 Randomization RED Intervention N=374 Usual Care N=375 30-day Outcome Data
- Telephone Call
- EMR Review
Randomized Controlled Trial
Enrollment Criteria:
- English speaking
- Have telephone
- Able to independently consent
- Not admitted from institutionalized setting
- Adult medical patients admitted to Boston Medical Center (urban academic safety-net
hospital) 48% Medicaid + 22% Free Care
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Primary Outcome:
Hospital Utilization within 30d after dc
Usual Care (n=368) Intervention (n=370) P-value Hospital Utilizations *
Total # of visits Rate (visits/patient/month)
166 0.451 116 0.314 0.009 ED Visits
Total # of visits Rate (visits/patient/month)
90 0.245 61 0.165 0.014 Readmissions
Total # of visits Rate (visits/patient/month)
76 0.207 55 0.149 0.090 * Hospital utilization refers to ED + Readmissions
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Cumulative Hazard Rate of Patients Experiencing Hospital Utilization 30 days After Index Discharge
5 1 0 1 5 2 0 2 5 3 0 0 .0 0 .1 0 .2 0 .3
Cum ulative Hazard Rate Tim e after I ndex Discharge ( days)
Usual care Intervention p = 0.004
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Outcome Cost Analysis
Cost (dollars) Usual Care (n=368) Intervention (n=370) Difference Hospital visits 412,544 268,942
- 143,602
ED visits 21,389 11,285
- 10,104
PCP visits 8,906 12,617 + 3,711 Total cost/group 442,839 292,844
- 149,995
Total cost/subject 1,203 791
- 412
We saved $412 in outcome costs for each patient given RED
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ACP Decisions Video Library
Categories
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Education can Significantly Improve Decision-Making
Video Decision Support Tools for ACP Quality Metrics
Knowledge Decision certainty Stability of preferences
Very well accepted by patients
Helpful Comfortable Recommend
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ACPDecisions.org
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- Emulate face-to-face communication using
touch screen
- Develop therapeutic alliance using
Empathy Gaze Posture Gesture
- Tailored information
- Longitudinal conversation
Embodied Conversational Agent
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ECA – Educator at the time of discharge from the hospital Who Would You Rather Receive Discharge Instructions From? N= 143
1=definitely prefer doc, 4=neutral, 7=definitely prefer agent
36% prefer agent 48% neutral 16% prefer doc or nurse
“I prefer Louise, she’s better than a doctor, she explains more, and doctors are always in a hurry.” “It was just like a nurse, actually better, because sometimes a nurse just gives you the paper and says ‘Here you go.’ Louise explains everything.”
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Intervention to Promote Walking in Older Adults
Based on qualitative methods with members of our target audience, poor older adults, we designed “Tanya” to promote exercise behavior based on Social Cognitive Theory and the Transtheoretical Model of change
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The ECA “Talks” and the user responds by touching
- ptions on the screen
Bickmore, Silliman, Nelson, Cheng, Winter, Henault, Paasche-Orlow. J Am Geriatr Soc. 2013
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Advanced Illness Support
Continual support over six months for
Symptom Management Stress Management Physical Activity Promotion Advanced Care Planning Support Spiritual Counseling
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Smartphone ECA
Afib Kardia
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IVR – Post Medication Rx
EMC2 --> 50% -- > 50% !
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