Consensus Organizational Health Literacy Quality Improvement Measures
The healthcare system is complex. Healthcare organizations that pursue organizational health literacy (OHL) make things easier for patients by making changes to improve communication and to help patients find their way around, become engaged in the healthcare process, and manage their health.
AHRQ has produced many resources to guide OHL quality improvement initiatives. Measurement is a key part of the quality improvement process. CAHPS® health literacy items provide a set of validated patient survey items that healthcare organizations can use to measure their progress in OHL improvement from their patients’ perspective.
Now AHRQ has identified measures that organizations can use to monitor their efforts to improve OHL that do not rely on patient reports. AHRQ found 233 possible measures, mostly through a literature review and interviews with 20 organizations working to improve OHL. A panel of experts, including a patient representative, found the following 22 measures to be useful, meaningful, feasible, and to have face validity.
| Consensus Organizational Health Literacy Quality Improvement Measures | |
|---|---|
| Measure Name | Description |
|
OHL Domain: Organizational Structure, Policy, and Leadership |
|
|
Leadership Support of Health Literacy Efforts |
Percentage of leaders who attended health literacy awareness activity |
|
Patient and Family Engagement (PFE) Leader or Functional Area |
Hospital has a person or functional area, who may also operate within other roles in the hospital, that is dedicated and proactively responsible for patient & family engagement (PFE) and systematically evaluates PFE activities (i.e., open chart policy, PFE trainings, establishment and dissemination of PFE goals) |
|
Patient and Family Advisory Council or Representative on Quality Improvement Team |
Hospital has an active Patient and Family Engagement Committee (PFEC) or at least one former patient that serves on a patient safety or quality improvement committee or team |
|
Patient(s) and Family on Hospital Governing and/or Leadership Board |
Hospital has at least one or more patient(s) who serve on a Governing and/or Leadership Board and serves as a patient representative |
|
OHL Domain: Communication |
|
|
Screening for Preferred Spoken Language for Healthcare |
Percentage of hospital admissions, visits to the emergency department, and outpatient visits for which preferred spoken language for healthcare is identified and recorded |
|
Patients Receiving Language Services Supported by Qualified Language Services Providers |
Percentage of patients who state a preference to receive spoken healthcare in a language other than English who have documentation in their electronic health record that they received initial assessment and discharge instructions supported by trained and assessed interpreters or bilingual providers, workers, or employees assessed for language proficiency |
|
Patients Receiving Language Services During Consent Discussions |
Percentage of informed consent discussions for patients with limited English proficiency that have documented involvement of an interpreter |
|
Staff Trained to Use Teach Back |
Percentage of staff who report being formally trained to use the Teach Back method |
|
Patients Correctly Teaching Back Discharge Instructions |
Percentage of discharged patients who correctly taught back discharge instructions |
|
Care for Older Adults – Medication Review |
Percentage of adults 66 years and older who had a medication review |
|
OHL Domain: Ease of Navigation |
|
|
Followup Appointment Scheduling |
Percentage of patients who get followup appointments made upon discharge |
|
Referral Report Received |
Number of patients with a referral, for whom the referring provider received a followup report from the provider to whom the patient was referred |
|
OHL Domain: Patient Engagement & Self-Management Support |
|
|
Inpatient Education Received |
Percentage of inpatients given patient education on bedside tablet who complete the education module |
|
Screening for Nonmedical Needs |
Percentage of patients screened for non-medical needs |
|
Referral for Nonmedical Needs |
Percentage of patients who screened positive for needing non-medical support who were referred for services |
|
Self-Management Goals |
Percentage of patients with diabetes who have set a self-management goal |
|
Planning Checklist for Scheduled Admissions |
Prior to admission, hospital staff provide and discuss a discharge-planning checklist with every patient who has a scheduled admission, allowing for questions or comments from the patient or family (e.g., a planning checklist that is similar to the Centers for Medicare & Medicaid Services' Discharge Planning Checklist) |
|
Shift Change Huddles/Bedside Reporting |
Hospital conducts shift change huddles for staff and does bedside reporting with patients and family members in all feasible cases |
|
Postdischarge Phone Call |
Percentage of discharged patients for whom post-discharge phone call was completed |
|
Measures That Cut Across Domains |
|
|
Health Literate Healthcare Organization-10 (HLHO-10) Score |
Computed score based on hospital administrator's responses to 10 questions designed to assess the 10 attributes of a health literate healthcare organization |
|
Health Literate Discharge Score |
Computed score based on staff responses to 36 questions addressing language preferences/needs, communication regarding needed followup appointments, medication review, readability of written care plan, patient education, and followup after discharge |
|
Overall Health Literacy Environment Rating |
Sum of 5 domain scores based on Health Literacy Environment Review: navigation, print communication, oral exchange, technology, and policies & protocols |
Note: Many consensus OHL measures were developed for hospitals, but could be used in other settings.
Although these measures span the domains of OHL, each measure was assessed individually and together do not constitute a comprehensive set for OHL measurement. For more information, consult the article, “Organizational Health Literacy: Quality Improvement Measures with Expert Consensus."
