Implementing Routine Health Literacy Assessment in Hospital and Primary Care Patients
Implementing Routine Health Literacy Assessment in Hospital and Primary Care Patients
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DOI：
10.1016/s1553-7250(14)40008-4
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发表时间：
2014-02-01
影响因子：
2.3
通讯作者：
Kripalani, Sunil
中科院分区：
文献类型：
--
作者：
Cawthon, Courtney;Mion, Lorraine C.;Kripalani, Sunil
背景：健康素养不足的患者通常健康状况较差，利用率和费用增加。医学研究所建议将卫生知识评估纳入卫生保健信息系统，这将有助于对卫生知识的影响进行大规模研究，并有助于评价系统干预措施，通过卫生知识的普及来改善护理。作为健康素养筛查（HEALS）研究的一部分，一个简短的健康素养屏幕（BHLS）被纳入电子健康记录（EHR）在一个大型的学术medical center.Methods：实施变化的护理摄入文件在所有的成人医院单位，急诊科，和三个初级保健的做法。这一变化涉及用BHLS取代以前的教育筛查项目。执行工作以质量改进框架为基础，重点是可接受性、采用性、适当性、可行性、忠实性和可持续性。从护理领导层获得支持，提供教育和培训，推出文件变更，获得反馈，并监测新的健康素养筛查项目的吸收情况。结果：2010年11月至2012年4月期间，有55,611名成人住院患者，2010年11月至2011年9月，23,186名成人患者住院39人，对三个初级保健诊所进行了595次门诊访问。完成（摄取）率为91.8%的医院和66.6%的门诊clinics.Conclusions：虽然存在的挑战，它是可行的，将健康素养筛查纳入临床评估和EHR文件。下一步是评估健康素养与住院和门诊人群的护理过程和结果之间的关联。
Background: Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a Brief Health Literacy Screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center.Methods: Changes were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Support was gained from nursing leadership, education and training was provided, a documentation change was rolled out, feedback was obtained, and uptake of the new health literacy screening items was monitored.Results: Between November 2010 and April 2012, there were 55,611 adult inpatient admissions, and from November 2010 to September 2011, 23,186 adult patients made 39,595 clinic visits to the three primary care practices. The completion (uptake) rate was 91.8% for the hospital and 66.6% for the outpatient clinics.Conclusions: Although challenges exist, it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations.