What You Don't Know Can Hurt You

Is it possible for a health care system to redesign its services to better educate patients to deal with their immediate health issues and also become more savvy consumers of medicine in the long run?

Dean Schillinger, MD

The answer is yes, according to a study led by scientists at the University of California, San Francisco (UCSF) and San Francisco General Hospital and Trauma Center (SFGH) that was recently reported by the Institute of Medicine (IOM).

The team’s paper describes ten attributes that health care organizations should utilize to make it easier for people to better navigate health information, make sense of services and better manage their own health — assistance for which there is a profound societal need.

Some 77 millions people in the United States have difficulty understanding even very basic health information, which clouds their ability to follow doctors’ recommendations, and millions more simply lack the skills necessary to make clear, informed decisions about their own health care, said senior author Dean Schillinger, MD, a UCSF professor of medicine, chief of the Division of General Internal Medicine at SFGH, and director of the Health Communications Program the UCSF Center for Vulnerable Populations at SFGH.

“Depending on how you define it, nearly half the U.S. population has poor health literacy skills,” he said.

“Over the last two decades, we have focused on what patients can do to improve their health literacy,” he said. “In this report, we look at the other side of the health literacy coin, and focus on what health care systems can do.”

Emerging from an IOM Roundtable that brought together leaders from academia, industry, government agencies, non-profit organizations and patient and consumer interest groups, the new paper examines the programs, practices, attitudes and attributes of organizations that create environments that foster health literacy.

Why Health Literacy is So Important

The importance of enhancing health literacy has been demonstrated by numerous clinical studies over the years, said Schillinger, many of them carried out at UCSF. Health literacy is linked directly to patient wellness. People who are adept at understanding health information tend to make better choices, are better able to self-manage their chronic conditions, and have significantly better outcomes than people who do not.

Adults with low health literacy may find it especially difficult to navigate the healthcare system, and are more likely to have higher rates of serious medication errors, more emergency room visits and hospitalizations, gaps in their preventative care, increased likelihood of dying, and even poorer health outcomes for their children.

A number of health policy organizations have recognized that health literacy not only is important to individuals, but also benefits society because helping patients help themselves is an important pathway to keeping down health care costs. Successful self-management reduces disease complications and can cut down on unnecessary emergency room visits and eliminate other wasteful spending

Organizations that promote proper health literacy tend to do certain things very well. The ten attributes in the report include items such as:

• Making improving health literacy a priority at every level of the organization;
• Measuring health literacy and using those measurements to guide their practices;
• Taking into account the particular needs of the populations they serve;
• Avoiding stigmatizing people who lack health literacy;
• Providing easy access to health information and assistance navigating services;
• Distributing easy-to-understand information across print, audiovisual, and social media channels;
• Taking health literacy into account when discussing medicines or in other high-risk situations by using proven educational techniques, such as the teach-back method;
• Training the healthcare workforce in health communication techniques; and
• Letting patients know what their insurance policies cover and what they are themselves responsible for paying.

A complete description of ten attributes that define health-literate health care organizations can be found at the following links:

The report, “Ten Attributes of Health Literate Health Care Organizations” by Cindy Brach, Debra Keller, Lyla M. Hernandez, Cynthia Baur, Ruth Parker, Benard Dreyer, Paul Schyve, Andrew J. Lemerise, and Dean Schillinger was published by the IOM in June 2012. Here is the appendix.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.