Maureen Larkin from HealthLeaders wrote an interesting piece today, “Work With Me, Doc,” about issues of health literacy and the pressure on consumers to digest health information. She makes some interesting points about how much responsibility should consumers bear for learning about their health issues outside of their doctors’ offices.

In a white paper that the IxCenter published with the Foundation for Informed Medical Decision Making a few months back, some patient-centered care and shared decision-making (SDM) experts raised some similar issues. When we interviewed one of these experts, Susan Edgman-Levitan, she reported, “What I run into frequently with patients when we talk about shared decision making is they get really nervous that we’re expecting them to be their own doctors.”

In that paper, we try to clarify what SDM is all about, but no doubt semantics get in the way of what we’re really trying to communicate. In fact, the goal behind information therapy (Ix) is to make it easier for clinicians and patients to use health information together as a communication tool to promote better and more productive interaction between them in the limited one-on-one time they have together.

But there is no doubt a growing issue related to how much responsibility is being delegated to consumers. The reality is that it’s perceived diferently by different people; one person’s empowerment is another person’s burden. What we need to do with Ix initiatives is match the dose, frequency and duration of Ix to the individual’s needs and desires.

Research continues to show that patients do not remember - or understand - everything they are told when they are discharged from medical facilities.  An earlier Ix Blog post on health literacy and patient recall discussed findings such as 14% of patients being unaware of the fact that their physician had prescribed a new medication for them.

A more recent article in the Annals of Emergency Medicine found a strong tendency for patients to overestimate their understanding of emergency department (ED) care and discharge instructions.  Patients had more difficulty understanding post-ED discharge care instructions than information about the diagnosis and cause of their illness, ED care, or return instructions.

This research finding suggests that asking patients whether or not they understand medical instructions is not an adequate way to measure comprehension.  Although handwritten or printed discharge instructions are considered a best practice, this should not be the only method of communicating discharge instructions to patients.  Asking patients to explain information or instructions in their own words may be a better strategy for assessing patient understanding and providing clues about where to focus further discussion and explanation.

This month’s issue of Mayo Clinic Proceedings has two interesting studies and an insightful editorial (”Medication Literacy Is a 2-Way Street”) that highlight why information therapy (Ix) is so valuable at the end of a hospital stay.

Kripalani et al found that, for patients with limited literacy skills discharged for acute coronary syndrome, 22% had not filled their prescriptions and 21% had difficulty understanding the purpose of the drugs prescribed to them. Maniaci et al studied well-educated patients discharged from an internal medicine hospital ward with at least one new medication prescribed. This study found that, 1-2 weeks post-discharge, 14% were unaware of being given a new medicine. Much worse were the percentages of patients that could recall the name (64%), dosage (56%) or purpose (64%) of the drugs.

It’s clear that providers are not doing an adequate job of ensuring that patients are leaving the hospital with the information they need to manage their recovery effectively. But it’s largely not due clinician error; rather, it’s that little has been done to integrate that information transfer into the care delivery process–especially at critical moments in care such as the discharge process.

That’s why Ix is so critical to ensuring that discharged patients can recover to better health and reduce the chances of being readmitted. Innovative Ix leaders from around the country will be sharing best practices on how to change care delivery to meet patients’ information needs at the 7th Annual Conference. Please join us June 12-13 in Washington, DC to get engaged in this critical element of patient-centered care delivery redesign.

African American men have the highest incidence and death rates for prostate cancer than any other racial/ethnic group in the US.  How can information therapy (Ix) promote increased health equity in prostate cancer outcomes?  One of the functions of Ix is to deliver relevant health information to consumers where they are – in this case, the barber shop.

Research suggests that community-based education efforts by barbers could increase prostate cancer screenings among African American men.  Barbers were trained on an educational intervention based on the principles of Paulo Freire’s critical pedagogy.  In this ongoing pilot study, barbers ask male clients over the age of 40 if they have been screened for prostate cancer.  Clients who have not been screened are educated about prostate cancer and informed that they are a candidate for screening.

The training resulted in a statistically significant increase in barbers’ knowledge of prostate cancer.  Screening rates are not yet available, but preliminary results from qualitative interviews indicate increased knowledge about prostate cancer in clients.

If you are interested in promoting health equity, join us at the 7^th Annual Ix Conference in Washington, DC on June 11 and 12.  The Ix and Health Disparities track on June 12 will address promising new interventions that have been developed to narrow health disparities.

Last week, the California HealthCare Foundation released a new “Snapshot” report titled, “Just Looking: Consumer Use of the Internet to Manage Care.” It’s a great title–not only clever but descriptive of what seems to be going on in California right now.

Although a majority of Californians are using the Internet to search for answers to their health questions, only between 1 in 10 and 1 in 8 are using it to fill a prescription, communicate with a clinician, or make an appointment. Between one quarter and one third of Californians are using the Web to find a physician, assess clinicians, or review benefits or claims information.

These data are hardly a surprise and are very much in keeping with what is going on around the country. Why is the Internet still mostly being used this way?

Certainly, much of it is due to the inadequate connection between consumers’ lives of on the Web and their lives in their doctors’ offices. We know from the Pew Internet Project that–when clinicians ignore consumers’ queries generated by Internet searching–frustrated consumers don’t stop searching, they just keep what they’re doing from their doctors.

The moment in care when a consumer is searching for information is the perfect time to connect him or her to some other health care management resource–whether human or electronic. We need to figure out how to weave those connections into the care delivery process. We also need to figure out that we can make sure that the content they find is understandable, meaningful and actionable to consumers.

That’s part of what makes an information therapy (Ix) “killer app”–which is one of the highlights of the 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care.” In the Killer Apps session, James Hereford (EVP of Strategic Services & Quality at Group Health Cooperative in Seattle) and Susan Edgman-Levitan (who runs Mass General’s Stoeckle Center for Primary Care Innovation in Boston) will share both their visions and their experiences with implementing such Ix initiatives in very different real-world settings.

We have added a new session to the Ix & Health Disparities Track at the 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care.

In collaboration with the U.S. Department of Health & Human Services (HHS), we will hold a session titled, “Ix Initiatives to Overcome Health Disparities: Strategic Planning and Implementation in the Public & Private Sectors.” Three HHS leaders–Chuck Friedman, PhD, Deputy National Coordinator for HIT, Linda Harris, PhD, from the Office of Disease Prevention & Health Promotion, and Ahmed Calvo, MD, MPH, Chief Medical Officer for the Health Disparities Collaborative at HRSA (Health Resources & Services Administration)–are combining with a private sector perspective, Elisa Stomski, MPH, Clinical Research Manager at WellPoint/Anthem Blue Cross.

HHS and stakeholders around the country are building an ambitious agenda for the country to use health communication and HIT to overcome health disparities and improve health and health care delivery for everyone. This session will highlight the process by which HHS is incorporating health communication and HIT into Healthy People 2020. HHS will also report on implementation of related “expanded care model” strategies being deployed at community health centers across the country. For a private sector perspective, WellPoint will share its experience in health improvement outreach to a diverse range of Latino populations.

This will be at the of one of two tracks on the second day that will lead us into some working lunches to develop new learning collaboratives and/or special interest groups for moving Ix initiatives forward.

The Center for Children and Families at the Georgetown Health Policy Institute has just released a series of issue briefs on “Strengthening Medicaid.” I authored one of these papers, “Health Information Technology: Innovative Applications for Medicaid,” which discusses strategies that states can use to improve the quality and efficiency of Medicaid programs. The paper addresses how HIT relates to health disparities, health literacy, and the digital divide.

To see more about these issues, see the robust Ix discussion on the patient-centered health information technology (PCHIT) blog.

Lots of interesting Ix-related stories have been in the media recently, but none more dramatic than the study from the Archives of Internal Medicine that demonstrated a significant relationship between inadequate health literacy and all-cause mortality in seniors. In fact, Baker et al (7/23/07; abstract at http://archinte.ama-assn.org/cgi/content/short/167/14/1503) found that literacy is a more powerful predictor of death than education.

The authors also highlight past research that links inadequate health literacy to less knowledge and worse self-management skills for people with chronic disease.

This research should reinforce the call to action to deliver information to people that is tailored to their individual needs. Although using plain language is one useful strategy, effective tailoring requires multiple tactics–such as understanding individual needs and preferences better, addressing different learning styles, and delivering information through different media (print, electronic, video, audio, phone, etc.).

With the support of the California HealthCare Foundation, the United Hospital Fund, Kaiser Permanente, and the Group Health Community Foundation, IxCenter will launch a Patient-Centered Health Information Technology Initiative later this year. We will be assisting a diverse range of organizations in implementing HIT applications that focus on engaging consumers in care delivery. Although it will surely come up with all sites, particularly in our work with safety-net populations, we anticipate learning a lot about how to overcome health literacy barriers with innovative solutions.

In the interim, I’d love to hear your ideas for delivering tailored information in such situations.

–Josh