Patient Instructions for Health Literacy and Language Barriers: Values & Challenges Charles Lee, MD President & Founder Polyglot Systems, Inc. Polyglot Systems, Inc., 2000 Aerial Center Parkway, Suite 101, Morrisville, NC 27650. 2014
Polyglot Systems, Inc. Started 2001 (Morrisville, NC) Missioni Develop practical, affordable multilanguage technology solutions to improve healthcare access and reduce disparities for underserved and limited English proficient patients
Health Literacy: Our Approach (vs. Skill) Gather Understand Act Consolidate information Focus on key messages Remove clutter / reduce noise Reading level Language (written & verbal) Visuals Font size (elderly & visually impaired) Specific actions Encourage dialogue Personalized
Medication Summary: Improving Medication Adherence 4
Reducing Non-Adherence 3 month study of Meducation Calendar feature at Veteran s Administration 56% Overall Reduction 79% Improvement * Publication pending. 5
meducation Medication Safety National Institute for Minority Health & Health Disparities SBIR (R44MD001212) Reading level: 5 th -8 th Key messages: How to use safely Universal Medication Schedule Pictograms for dosing 3 Font sizes Multi-language support Free patient portal Demonstration for complex meds
meducation Challenge
meducation 19 Languages English Spanish Mandarin Cantonese Korean Haitian Creole Italian French Arabic Russian Bengali Polish Karen Burmese Somali Swahili Vietnamese Yiddish
Mobile Patient Education
UCONN: HCAHPS score HCAHPS rank increased with Meducation from 1 st / 1 st / 4 th to 85 th / 98 th / 52 nd Scores affect Medicare reimbursements
MeducationDC Meducation DC Improving Transitions of Care National Institute for Minority Health & Health Disparities SBIR (R44MD003050) English Spanish (Dual column) Spanish (single column)
MeducationDC Improving Transitions of Care
MeducationDC NIH Study Subjects Language Access Coordinators (n=25) Healthcare Providers (MD, RN) involved in discharge (n=8) Patients who speak another language (n=61) 28.3% preferred foreign language for written information 68.3% preferred English 3.3% no preference
31P 3:1 Preference
71P 7:1 Preference
What words would you use to describe an organization that provides these types of written instructions? Accommodating Amazing Appreciated Careful Caring Civilized Clever Committed Compliant Confident Conscientious Considerate Consistent Creative Customer-Centered Cutting Edge Diligent Engaged Excellent Extremely Important Fantastic Fills a need Friendly Gives me warm feeling Good Helpful Impressive Inclusive Not Left Alone Organized Patient centered Patient oriented Personal Prepared Professional Quality Reduce Anxiety Reliable Responsible Safety Smart Supporting Tech-Savvy Thankful Thorough Thoughtful Trust-worthy Trusted Understanding Very nice
Challenges: Science & Art Science: Universal Medication Schedule Grade reading level Visual layout Font sizes Education reinforcements Art: What are the key points? What do you leave out? ( Quick Start Sheet ) Lowest grade reading level l is NOT always better Visual representations (Ex. Food: Sandwich, Pizza, Bowel of Rice)
Challenges: Grade Reading Level 1) Flesch Reading Ease Formula = 206.835 (1.015 x ASL) 84.6 x ASW) 2) Flesch-Kincaid Grade Level Readability Test = (0.39 x ASL ) + (11.8 x ASW) 15.59 3) Fry Graph Readability Formula = X: Average # syllables /100 words Y: Average # sentences / 100 words 4) Gunning s FOG Index = 0.4 (ASL + PHW) 5) SMOG = 3 + SRPC ASL = Average sentence length ASW = Average number of syllables per word PHW = Percentage of hard words SRPC = Square root of polysyllable count
Challenges: Selling Health Literacy Current: HIT Vendors not high priority market not asking Providers need this in work flow doing too many things Meaningful use checkbox mentality quantity vs. quality
Challenges: Selling Health Literacy Trending: ACOs &PCMH Payments based on outcomes Need engaged, g educated patients More professional aware of health literacy Recommend: It s not my responsibility HIT Integration: Chicken & egg Automatic in work flow Environment for sharing & sustainable tools Stop hoping that patient will figure it out