From the
President
Wayne Tuckson, MD
GLMS President | [email protected]
A MODEST PROPOSAL to Improve Health Literacy
H
ealth outcomes are the yardsticks
by which we as physicians are now
measured. Fair or unfair, such is the
theatre in which we now operate. If
we do not perform to standard, then
we should be penalized, but we have little or no
control over most factors that influence health
outcomes. Should we be held accountable for
poor outcomes resulting from factors that lie
outside our sphere of influence? I say no.
The relationship between physicians and
hospitals is antagonistic, symbiotic and rarely
trusting. This familiar relationship must now
be discarded. We are in the age of value-based
models where responsibility for care delivery and
costs are divided amongst the participants. The
more familiar models are Accountable Care Or-
ganizations (where providers and hospitals agree
to take financial responsibility for the quality
of care), Clinically Integrated Networks (often
provider-based with better outcomes based upon
data driven metrics), Patient Centered Medical
Homes (the medical home with patient involve-
ment), and Population Health Service Organi-
zations (PHSO), where an emphasis is placed
on population health management utilizing
non-physicians.
Of these, the PHSO is unique in that it ad-
dresses variables that are outside our sphere of
influence, yet still influence outcomes. The 2017
Louisville Metro Department of Public Health
and Wellness Health Equity Report grouped
the root causes of poor health outcomes into 11
groups: food systems, health and human services,
early childhood development, criminal justice,
employment and income, housing, transporta-
tion, environmental quality, built environment,
neighborhood development, and education.
Reasonable people can appreciate that these
“root causes” can affect health outcomes, but
many may not understand or agree on how to
address them. Health care is a business, but to
paraphrase Jacob Marley, the welfare of mankind
is also our business. When we are mandated
to perform non-direct patient care work with
little or no compensation, can we fault the busy
clinician who balks at becoming engaged in one
more problem that lies outside the office door?
Health literacy is one problem that we can
address which negatively impacts health out-
comes. Health literacy is “the degree to which
individuals have the capacity to obtain, process
and understand basic health information and
services needed to make appropriate health
decisions”. Though literacy and health literacy
overlap, there are differences. However, too often
those lacking in basic comprehension skills are
often ill equipped to be full participants in their
own or their family’s health care. Of course, when
one adds language and cultural differences, the
field is further muddied.
The impact of a deficiency in health litera-
cy is manifest in failure to keep appointments,
failure to take medications as prescribed, failure
to complete a course of treatment, failure to get
screenings or preventative services, an increase
in preventable hospital visits, and inappropri-
ate use of the ER. Many, if not all of these, will
negatively impact our new value-based system
of reimbursement models. Addressing health
literacy may have an immediate impact without
increasing our costs or workload.
Efforts aimed at simplifying information
and working with target populations to be sure
the material is culturally relevant and available
on different media platforms, and available at
times convenient for the patient and their family
members has shown good results. At the same
time, we must be sensitive to the concerns of the
patient and the peripheral issues that influence
their illness or condition.
Time is a precious commodity in the exam
room. More has to be done outside the office and
hospital doors. Enter the Community Health
Worker (CHW). CHW’s are laypeople, often
members of a target community, who help pro-
vide basic health and medical care, bridge cul-
tural and linguistic barriers, and expand access
to coverage and care within their community.
The use of lay-health workers in a rural com-
munity hospital in Appalachian Kentucky result-
ed in a 77 percent decrease in 30-day readmission
rates for high-risk patients and the reduction in
t he 30-day readmission rate resulted in a sig-
nificant return which far exceeded the initial
investment. Face-to-face interactions between
CHW’s and patients resulted in an increase in
patient participation in their care and a seven
percent increase in patients who sought col-
orectal cancer screening following intervention
by a CHW.
By improving health literacy, CHW’s work-
ing with physicians can together improve health
outcomes. The utilization of CHW’s cannot be
like the interpreter, someone we must have, but a
cost that is passed on to the physician. Together
physicians, health care systems and insurers,
both private and government, must make the
initial investment in ideas like CHW’s. Then
together we can reap the rewards of cost savings
and improved health outcomes.
There are many things that lie outside the
hospital and physician’s office door with which
we must engage to improve health outcomes.
Many will overly tax the time and resources
of the busy clinician. However, improving the
communication between patient and physician
through direct interaction or, better still, through
resources like CHW’s working with physicians
is doable. With CHW’s working with physicians
we can improve the health of our community. If
another reason is needed, such actions will later
improve the bottom line. Ben Franklin said it
best, “Do well by doing good.” The community
will benefit in the long run.
Dr. Tuckson is a practicing colon and rectal surgeon.
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Louisville Metro Health Equity Report
2017
U.S. Department of Health and Human
Services, Office of Disease Prevention
and Health promotion. 2010 National
Action Plan to Improve health Literacy
Cardarelli R, et al. Health Educ
Res.2018
Cardarelli R, et al. J Rural Health. 2017
Feltner FJ, et al. Social Work in Health-
care.2012
JULY 2018
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