Intervention: Intake forms should be written at a 6^th grade reading level at New York-Presbyterian Hospital, Queens.

 

Scope of the Problem

It is estimated that around 80 million adults in the United States have a limited health literacy. This places them at a higher risk for poor health outcomes. There is an increased prevalence of low literacy among the elderly, minorities, poor persons, and those with less than a high school education. This is becoming an expanding issue in Jamaica, Queens. Close to 30% of the population in Jamaica have not completed high school. 17% of the population in Jamaica is reported to live below the poverty level, and 15% are unemployed. Only 37% of adults in Jamaica receive an annual dose of the Influenza vaccine. In addition, 45.8% of the population in Jamaica, Queens is foreign born, 10.7% of households in Jamaica, Queens are limited English speaking. All of these factors contribute to low health literacy.

Low health literacy has been associated with expanded use of certain health care services. These include increased hospitalizations and emergency department visits, as well as decreased mammography screening and influenza immunizations. Low health literacy leads to poorer abilities to take medications properly, decipher medication labels and health messages among others. New evidence shows that lower health literacy is at least partially linked to racial disparities, which lead to lower health outcomes in certain populations.

 

Planning

The goal of this intervention would be to increase patient communication and understanding at New York-Presbyterian Hospital, Queens (NYHQ). The main stakeholders of this policy are the board of directors and management team of the hospital. I would get their buy-in by explaining the benefits of the intervention, and how it can improve health outcomes in the hospital, without much financial risk. Studies have shown that 20% of low literate patients with diabetes have tight control of their blood sugar level, compared to the 33% of patients with adequate health literacy who have tight control of their blood sugar levels. Additionally, limited literacy Medicaid enrollees accumulate an average of $10,688 in health care costs annually, compared to the $2,891 in health care costs that enrollees with adequate literacy accumulate annually. Hospitals are evaluated largely by their outcomes. Having a method that wouldn’t increase their financial burden, but may improve their outcomes should be quit appealing. Based on the numbers from the Medicaid study, this intervention may even help the hospital bring down costs.

In order to find out more information regarding the average population at NYHQ and their level of health literacy, I would hand out simple surveys, in a variety of languages, to patients in the waiting rooms at various points in the hospital. The surveys would include questions that would indicate their health-literacy level. Example of such questions could be:

• how often are you confused about how often to take your medication?
• Have you had a challenging time figuring out the steps needed to make your appointment today?

I would phrase the questions to indicate that the hospital wants to make some changes and that their input is needed to assess what needs improvement. I would also put together a focus group to ask them about their shared experience while navigating the healthcare scene. The program would not need specific funding, the same ink and that is currently used to create the intake forms would be used to print the new ones. This program does not need a lot of funding or risk, but has the potential to directly impact patient experiences at the hospital, and possibly even health outcomes. For this reason, I believe that it has the ability to run long term.

 

Development & Dissemination of the Intervention

The goal of the intervention is to reduce the stress and improve communication at the beginning of the visit. For people with low health literacy, getting a stack of papers to fill out as soon as they get to the office can be very daunting. Many people who have a hard time filling them out are embarrassed and therefore won’t ask for help. If these intake forms were written at a 6^th grade reading level, it would significantly decrease the amount of people who have a hard time filling them out. In addition to placing the patients at ease, it would lead to increased accuracy in the information that the providers are receiving. The input for this intervention is very limited and simple, it just requires that the current intake forms gets replaced by ones that are at a 6^th grade reading level. No physical space, time or extra money is necessary to apply this intervention.

 

Evaluation & Maintenance

In the first six months, I would evaluate the program monthly by sending out the same surveys that were sent out originally and comparing the results to those from the original survey. After six months, I would hold two focus groups to evaluate patient’s shared experiences with the intervention. One would be for new patients who ever experienced the old forms, the other for chronic patients who remember the old forms and can comment on the difference. If all responses point to the program working, I would evaluate once more via surveys at the one-year mark. If the intervention is unsuccessful, I would bring back the old forms, and evaluate what other interventions could be made to better the healthcare experience for low health literate patients. If the program is successful, over the next 5-10 years I would change over more of the forms throughout the hospital to be at a 6^th grade reading level. I would reevaluate the program efficacy every 1-2 years. Because the intervention does not require a constant influx of money, nothing else would be needed to maintain the intervention.

Sources:

Schillinger, D., Grumback, K., Piette, J, et al. Association of health literacy with diabetic outcomes. JAMA. 2002;288:475-482.

Weiss, B.D., Palmer, R. Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population. J Am Board Family Pract. 2004;17:44-47.

http://www.statisticbrain.com/number-of-american-adults-who-cant-read/

https://www.researchgate.net/profile/Katrina_Donahue/publication/51501673_Low_Health_Literacy_and_Health_Outcomes_An_Updated_Systematic_Review/links/0912f50c75cf069c70000000/Low-Health-Literacy-and-Health-Outcomes-An-Updated-Systematic-Review.pdf

https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-qn12.pdf

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/docs/advocate_community_partners_awmedical/3.8_advocate_community_partners_cna.pdf

https://www.point2homes.com/US/Neighborhood/NY/Queens/Jamaica-Demographics.html

https://www.literacynewyork.org/literacy-facts