National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Arthritis (2)
- Asthma (1)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Clinician-Patient Communication (5)
- Communication (4)
- Community-Based Practice (1)
- Education: Patient and Caregiver (6)
- Elderly (3)
- Electronic Health Records (EHRs) (5)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Genetics (1)
- Healthcare Delivery (6)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (6)
- (-) Health Literacy (26)
- Health Services Research (HSR) (1)
- Health Systems (1)
- Hospital Discharge (2)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (3)
- Obesity (1)
- Obesity: Weight Management (1)
- Outcomes (1)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (6)
- Patient Experience (1)
- Patient Self-Management (1)
- Practice Patterns (1)
- Primary Care: Models of Care (1)
- Provider: Pharmacist (1)
- Quality Improvement (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (1)
- Risk (1)
- Shared Decision Making (5)
- Surgery (1)
- Telehealth (3)
- Tools & Toolkits (2)
- Urban Health (1)
- Vulnerable Populations (1)
- Web-Based (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 26 Research Studies DisplayedSilverstein GD, Styke SC, Kaur S
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
This study’s objective was to evaluate the associations between health/eHealth literacy and depressive symptoms with app usage and clinical outcomes. The authors recruited adults with persistent asthma to utilize the ASTHMAXcel PRO mobile app. Participants completed the following questionnaires: Patient Health Questionnaire-9 (PHQ-9) to assess for depressive symptoms, Asthma Control Test (ACT), Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign (NVS) tool to measure health literacy. Subsets of participant data were available on eHealth literacy (eHeals) (n = 24) and average number of app logins across 2 months (n = 40). The average participant age was 44.0 years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control and asthma QOL, but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL and more app logins. NVS scores weren’t associated with any measures.
AHRQ-funded; HS025645.
Citation: Silverstein GD, Styke SC, Kaur S .
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
Psychosom Med 2023 Sep 1; 85(7):605-11. doi: 10.1097/psy.0000000000001170..
Keywords: Health Literacy, Asthma, Telehealth, Health Information Technology (HIT), Education: Patient and Caregiver, Outcomes, Respiratory Conditions, Chronic Conditions
Lucy AT, Rakestraw SL, Stringer C
Readability of patient education materials for bariatric surgery.
This paper examined readability and reading level of online bariatric surgery and standardized perioperative electronic medical record (EMR) patient education materials (PEM). National organizations recommend that PEM not exceed a sixth grade reading level. One institution was used to assess readability of PEM. Text readability was assessed by seven validated instruments and mean readability scores calculated with standard deviations and compared using unpaired t-tests. A total of 32 webpages and seven EMR education documents were assessed. Web pages were overall assessed as "difficult to read" compared to "standard/average" readability EMR materials. All web pages were at or above high school reading levels, with the highest reading levels being pages with nutrition information and the lowest reading level patient testimonials. EMR materials were found to be at sixth to ninth grade reading level.
AHRQ-funded; HS023009.
Citation: Lucy AT, Rakestraw SL, Stringer C .
Readability of patient education materials for bariatric surgery.
Surg Endosc 2023 Aug; 37(8):6519-25. doi: 10.1007/s00464-023-10153-3..
Keywords: Surgery, Education: Patient and Caregiver, Obesity: Weight Management, Obesity, Health Literacy
Ahmed N, Brown J, Parau C
Bridging the digital health divide: characterizing patient portal users and nonusers in the U.S.
The purpose of this study was to 1) review variations in demographics between patient portal users and nonusers; and 2) review variations in health literacy, patient self-efficacy, and technology utilization and attitudes between patient portal users and nonusers. The researchers collected data from Amazon Mechanical Turk (MTurk) workers between December 2021 and January 2022. 489 Participants completed an online survey with questions on their attitudes about media and technology, attitudes about their health, their access to technology, health literacy, patient self-efficacy, and patient portal use. The study results indicated qualitative differences between users and nonusers of patient portals as related to type of neighborhood, income, education, disability status, comorbidity, type of insurance, and the presence or absence of primary care providers. Quantitative results supported the qualitative results, revealing that participants with insurance, a primary care provider, or a disability or comorbid condition had a greater likelihood of having a patient portal account.
AHRQ-funded; HS026298.
Citation: Ahmed N, Brown J, Parau C .
Bridging the digital health divide: characterizing patient portal users and nonusers in the U.S.
Med Care 2023 Jul; 61(7):448-55. doi: 10.1097/mlr.0000000000001869..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy
Stallings SC, Richmond SC, Canedo JR
Assessing patient-level knowledge of precision medicine in a community health center setting.
Researchers used a mixed-methods approach to identify patient-level factors that influenced understanding of cancer risk among federally qualified community health center (FQCHC) patients. Participants were English-speaking adults aged 40-79 years enrolled in focus groups; they completed surveys to assess patient-level understanding of precision medicine, numeracy, and health literacy. The findings suggested that patients may lack familiarity with precision medicine concepts relevant for understanding cancer treatment decisions. The researchers concluded that future educational efforts might help to bridge the gap in patient understanding and facilitate equitable opportunities for precision medicine for patients, including those seeking care from community health centers.
AHRQ-funded; HS026122.
Citation: Stallings SC, Richmond SC, Canedo JR .
Assessing patient-level knowledge of precision medicine in a community health center setting.
J Community Genet 2023 Apr; 14(2):197-210. doi: 10.1007/s12687-023-00632-4..
Keywords: Community-Based Practice, Health Literacy, Genetics
Arcia A, Pho AT, Lor M
Comparison of newest vital sign and brief health literacy screen scores in a large, urban Hispanic cohort.
The purpose of this study was to examine the relationship between Newest Vital Sign (NVS) and Brief Health Literacy Screen (BHLS) scores in a large cohort of English- and Spanish-speaking urban Hispanic adults. Scores on both measures showed good internal consistency but NVS items had high difficulty; greater than 50% of respondents scored 0. The correlation between measures was weak. The study concluded that health literacy scores were poor predictors of objective scores.
AHRQ-funded; HS019853; HS022961.
Citation: Arcia A, Pho AT, Lor M .
Comparison of newest vital sign and brief health literacy screen scores in a large, urban Hispanic cohort.
Patient Educ Couns 2023 Apr; 109:107628. doi: 10.1016/j.pec.2023.107628
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Keywords: Health Literacy, Racial and Ethnic Minorities, Urban Health
Lane S, Fitzsimmons E, Zelefsky A
Assessing electronic health literacy at an urban academic hospital.
The purpose of this study was to explore electronic health literacy (EHL) in patients at an urban, academic hospital in the Bronx, and evaluate for relationships between EHL levels and different demographic variables. The researchers designed a cross-sectional, observational study in adults 18 years or more who presented for services at the Montefiore Einstein Center for Cancer Care (MECCC) Department of Radiation Oncology or the Montefiore Department of Medicine in the Bronx. The study evaluated EHL using the existing, validated eHealth Literacy Scale (eHEALS) survey and the researchers’ newly developed eHealth Literacy Objective Scale-Scenario Based (eHeLiOS-SB) tool. The study found that there was a statistically significant relationship between age and EHL as evaluated by both eHEALS and eHeLiOS-SB, with lower EHL scores for older adults. A specific question designed to evaluate attitudes toward digital health technologies revealed that the majority of participants held a positive attitude toward those types of applications.
AHRQ-funded; HS025645.
Citation: Lane S, Fitzsimmons E, Zelefsky A .
Assessing electronic health literacy at an urban academic hospital.
Appl Clin Inform 2023 Mar; 14(2):365-73. doi: 10.1055/a-2041-4500..
Keywords: Health Literacy, Electronic Health Records (EHRs), Telehealth, Health Information Technology (HIT)
van den Bogert CA, Miller MJ, Cobaugh DJ
Screening questions for nonsteroidal anti-inflammatory drug risk knowledge.
The aim of this study was to evaluate screening questions for estimating nonsteroidal anti-inflammatory drug (NSAID) risk knowledge. It concluded that screening questions for subjective NSAID risk awareness and health literacy are predictive of objectively tested NSAID knowledge and can be used to triage patients as well as subsequently initiate and direct a conversation about NSAID risk.
AHRQ-funded; HS016956.
Citation: van den Bogert CA, Miller MJ, Cobaugh DJ .
Screening questions for nonsteroidal anti-inflammatory drug risk knowledge.
J Patient Saf 2017 Dec;13(4):217-22. doi: 10.1097/pts.0000000000000143.
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Keywords: Adverse Drug Events (ADE), Health Literacy, Medication, Risk
Brach C
AHRQ Author: Brach C
The journey to become a health literate organization: a snapshot of health system improvement.
This chapter explores the journey that a growing number of organizations are taking to become health literate. A part of the chapter highlights the experiences of three organizations that have explicitly set a goal to become health literate: Carolinas Healthcare System (CHS), Intermountain Healthcare, and Northwell Health. The chapter ends with lessons learned from the experiences of health literacy pioneers that may be useful to organizations embarking on the journey.
AHRQ-authored.
Citation: Brach C .
The journey to become a health literate organization: a snapshot of health system improvement.
Stud Health Technol Inform 2017;240:203-37.
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Keywords: Health Literacy, Health Systems, Quality Improvement
Wolinsky FD, Lou Y, Edmonds SW
Activating patients with a tailored bone density test results letter and educational brochure: the PAADRN Randomized Controlled Trial.
This study examined whether a tailored patient-activation letter communicating bone mineral density (BMD) test results plus an educational brochure improved patient activation scores and levels at 12 and 52 wk post-baseline as the mechanism leading to enhanced bone healthcare.
AHRQ-funded; HS023009.
Citation: Wolinsky FD, Lou Y, Edmonds SW .
Activating patients with a tailored bone density test results letter and educational brochure: the PAADRN Randomized Controlled Trial.
J Clin Densitom 2017 Oct/Dec;20(4):464-71. doi: 10.1016/j.jocd.2016.08.012..
Keywords: Education: Patient and Caregiver, Health Literacy, Patient-Centered Healthcare, Patient and Family Engagement, Clinician-Patient Communication
Liang L, Brach C
AHRQ Author: Liang L, Brach C
Health literacy universal precautions are still a distant dream: analysis of U.S. data on health literate practices.
This study sought to examine whether there has been an increase in the delivery of health literate care and whether recommendations for health literacy universal precautions are being followed. It found that the proportion of adults in the U.S. who reported receiving health literate care increased from 2011 to 2014, but fell far short of health literacy universal precautions recommendations of delivering health literate care to everyone.
AHRQ-authored.
Citation: Liang L, Brach C .
Health literacy universal precautions are still a distant dream: analysis of U.S. data on health literate practices.
Health Lit Res Pract 2017 Oct;1(4):e216-e30. doi: 10.3928/24748307-20170929-01.
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Keywords: Healthcare Delivery, Health Literacy, Medical Expenditure Panel Survey (MEPS), Clinician-Patient Communication
Morrow D, Hasegawa-Johnson M, Huang T
A multidisciplinary approach to designing and evaluating electronic medical record portal messages that support patient self-care.
The authors describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Their approach combines quantitative measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others.
AHRQ-funded; HS022948.
Citation: Morrow D, Hasegawa-Johnson M, Huang T .
A multidisciplinary approach to designing and evaluating electronic medical record portal messages that support patient self-care.
J Biomed Inform 2017 May;69:63-74. doi: 10.1016/j.jbi.2017.03.015.
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Keywords: Elderly, Electronic Health Records (EHRs), Health Literacy, Patient Self-Management, Web-Based
Abujarad F, Alfano S, Bright TJ
AHRQ Author: Bright TJ
Building an informed consent tool starting with the patient: the patient-centered Virtual Multimedia Interactive Informed Consent (VIC).
This paper describes how the authors designed, developed, and evaluated an mHealth tool for advancing the informed consent process. Their tool enables the informed consent process to be performed on tablets (e.g., iPads) utilizing virtual coaching with text-to-speech automated translation as well as an interactive multimedia elements (e.g., graphics, video clips, animations, presentations, etc.). They present the Used-Centered Design approach they adopted to develop the tool and the results of the different methods used during the development of the tool.
AHRQ-authored; AHRQ-funded; HS023987.
Citation: Abujarad F, Alfano S, Bright TJ .
Building an informed consent tool starting with the patient: the patient-centered Virtual Multimedia Interactive Informed Consent (VIC).
AMIA Annu Symp Proc 2017 Apr 16;2017:374-83..
Keywords: Health Information Technology (HIT), Health Literacy, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient Experience, Telehealth
Tieu L, Schillinger D, Sarkar U
Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?
The objective of this study was to examine specific usability barriers to patient portal engagement among a diverse group of patients and caregivers. In navigating the portal, participants experienced basic computer barriers (eg, difficulty using a mouse), routine computer barriers (eg, mistyping, navigation issues), reading/writing barriers, and medical content barriers.
AHRQ-funded; HS022408; HS022561.
Citation: Tieu L, Schillinger D, Sarkar U .
Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?
J Am Med Inform Assoc 2017 Apr 1;24(e1):e47-e54. doi: 10.1093/jamia/ocw098.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy, Vulnerable Populations, Web-Based
Unaka NI, Statile A, Haney J
Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.
A cross-sectional study was conducted at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. The investigators found that overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home.
AHRQ-funded; HS023827.
Citation: Unaka NI, Statile A, Haney J .
Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.
J Hosp Med 2017 Feb;12(2):98-101. doi: 10.12788/jhm.2688..
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Children/Adolescents
Ratanawongsa N, Barton JL, Lyles CR
Computer use, language, and literacy in safety net clinic communication.
The researchers investigated the associations between safety net clinician computer use and patient-provider communication for patients with limited health literacy (LHL) and limited English proficiency (LEP). They found that higher clinician computer use was associated with more biomedical focus with LEP/LHL patients, and clinician verbal dominance and lower ratings with patients with adequate English proficiency and health literacy.
AHRQ-funded; HS022561.
Citation: Ratanawongsa N, Barton JL, Lyles CR .
Computer use, language, and literacy in safety net clinic communication.
J Am Med Inform Assoc 2017 Jan;24(1):106-12. doi: 10.1093/jamia/ocw062.
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Keywords: Communication, Electronic Health Records (EHRs), Health Literacy, Clinician-Patient Communication, Health Information Technology (HIT)
Albrecht JS, Gruber-Baldini AL, Hirshon JM
Hospital discharge instructions: comprehension and compliance among older adults.
The purpose of this prospective cohort study was to quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics. The investigators concluded that non-comprehension of discharge instructions among older adults was prevalent, multi-factorial, and varies by domain.
AHRQ-funded; HS021068.
Citation: Albrecht JS, Gruber-Baldini AL, Hirshon JM .
Hospital discharge instructions: comprehension and compliance among older adults.
J Gen Intern Med 2014 Nov;29(11):1491-8. doi: 10.1007/s11606-014-2956-0..
Keywords: Elderly, Health Literacy, Hospital Discharge, Patient Adherence/Compliance
Griffey RT, Kennedy SK, D'Agostino McGowan L, Good RT, Kennedy SK, D'Agostino McGowan L
Is low health literacy associated with increased emergency department utilization and recidivism?
The study objective was to determine whether patients with low health literacy have higher emergency department (ED) use and higher ED recidivism than patients with adequate health literacy. It found that patients with inadequate health literacy had higher ED use compared to those with adequate health literacy.
AHRQ-funded; HS020309
Citation: Griffey RT, Kennedy SK, D'Agostino McGowan L, Good RT, Kennedy SK, D'Agostino McGowan L .
Is low health literacy associated with increased emergency department utilization and recidivism?
Acad Emerg Med. 2014 Oct;21(10):1109-15. doi: 10.1111/acem..
Keywords: Health Literacy, Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Shared Decision Making, Health Literacy, Patient and Family Engagement
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Shared Decision Making, Health Literacy, Patient and Family Engagement
Brach C
AHRQ Author: Brach C
A daughter's frustration with the dearth of patient- and family-centered care.
This article is a first-person account of a hospitalization that describes the lack of patient and family inclusion in decision-making, failure to use plain language and other health literacy strategies, and disregard for patient and family preferences. The author concludes that if the health care system is going to shift from paternalistic to patient- and family-centered, providers must be trained in how to communicate and partner with patients and families. The author references resources to help hospitals make systematic changes to hard wire health literate and patient- and family-centered care.
AHRQ-authored.
Citation: Brach C .
A daughter's frustration with the dearth of patient- and family-centered care.
Patient Exp J 2014 Apr 1;1(1):43-47.
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Keywords: Healthcare Delivery, Shared Decision Making, Health Literacy, Patient and Family Engagement, Patient-Centered Healthcare
Brach C, Dreyer BP, Schillinger D
AHRQ Author: Brach C
Physicians' roles in creating health literate organizations: a call to action.
Physicians are being called on to deliver patient-centered care, reduce medical errors, and generally increase health care quality and health outcomes, all while containing costs. Fully engaging patients in prevention, decision-making and self-management activities is critical to achieving these aims. The authors of this paper concluded that being health literate must be a new way of delivering care rather than an add-on. For national health literacy goals to be met, health care organizations must ingrain health literacy into their routines.
AHRQ-authored.
Citation: Brach C, Dreyer BP, Schillinger D .
Physicians' roles in creating health literate organizations: a call to action.
J Gen Intern Med 2014 Feb;29(2):273-5. doi: 10.1007/s11606-013-2619-6.
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Keywords: Healthcare Delivery, Shared Decision Making, Health Literacy, Patient and Family Engagement, Patient-Centered Healthcare
Shoemaker SJ, Staub-DeLong L, Wasserman M
Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.
The purpose of this study is to understand the facilitators and barriers to the adoption and implementation of AHRQ’s health literacy tools, particularly a tool to assess a pharmacy’s health literacy practices. The study found facilitators including awareness of health literacy, a culture of innovation, and a change champion. It also identified barriers such as lack of leadership support and limited staff time.
AHRQ-funded; 290200600011I
Citation: Shoemaker SJ, Staub-DeLong L, Wasserman M .
Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.
Res Social Adm Pharm. 2013 Sep-Oct;9(5):553-63. doi: 10.1016/j.sapharm.2013.05.003..
Keywords: Health Literacy, Education: Patient and Caregiver, Practice Patterns, Tools & Toolkits, Medication
Baur C, Brach C
AHRQ Author: Brach C
Pharmacy research on health literacy can contribute to national goals and health care system improvements.
Three key points about health literacy underscore the articles in this special issue: 1. Effective health communication utilizes both the spoken and written word; 2. A number of health literacy tools can help pharmacists implement health literacy practices; 3. Readability assessments can be a step on a path toward more productive provider–patient communication.
AHRQ-authored.
Citation: Baur C, Brach C .
Pharmacy research on health literacy can contribute to national goals and health care system improvements.
Res Social Adm Pharm 2013 Sep-Oct;9(5):498-502. doi: 10.1016/j.sapharm.2013.06.012.
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Keywords: Healthcare Delivery, Communication, Health Literacy, Provider: Pharmacist
Robertson J, Farris KB, Schultz SK
Older adults' views about "Managing Your Medications" booklet.
The objective of the study was to evaluate the Managing Your Medications (MYM) booklet to improve medication management. Older adults reported it was comprehensible and 17 percent reported behavioral intentions to change their current actions regarding medications. Overall, 12.7 percent of respondents agreed that MYM changed their opinion of the topic. The most popular means to dis¬seminate were doctors’ offices and senior citizens’ centers.
AHRQ-funded; HS016094.
Citation: Robertson J, Farris KB, Schultz SK .
Older adults' views about "Managing Your Medications" booklet.
J Appl Gerontol 2013 Apr;32(3):370-82. doi: 10.1177/0733464811421910..
Keywords: Elderly, Education: Patient and Caregiver, Health Literacy, Medication
Koh HK, Brach C, Harris LM
AHRQ Author: Brach C
A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.
The researchers proposed a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). Their new model calls for approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then confirming and ensuring patients' understanding. They suggested that health literacy would then become an organizational value infused into all aspects of planning and operations. They also proposed a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care.
AHRQ-authored.
Citation: Koh HK, Brach C, Harris LM .
A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.
Health Aff 2013 Feb;32(2):357-67. doi: 10.1377/hlthaff.2012.1205.
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Keywords: Healthcare Delivery, Shared Decision Making, Education: Patient and Caregiver, Health Literacy, Primary Care: Models of Care, Patient and Family Engagement