Health literacy systems in the safety net: Lessons from complex care management

描述（由申请人提供）：关于健康素养（HL）的研究已经确定需要对HL进行更复杂和细致入微的理解，将患者HL考虑在更大的背景下，包括其他患者、提供者和组织层面的动态。HL研究的最新进展已经开始调查提供者和医疗保健系统在塑造个人能力以满足其健康相关需求方面所起的作用，以及提供者和医疗保健系统对患者的HL相关需求。我们将这种更加情境化的HL概念称为“健康素养系统”，并建议通过研究患者-提供者-组织的互动、流程和安排，进一步了解HL系统，这些系统包括位于两个安全网机构的两个复杂护理管理（CCM）项目。由于《平价医疗法案》覆盖了以前参加联合国和W保险的人群，我们需要对HL系统有更广泛的了解，这种系统适用于我们社会中最弱势群体寻求护理的安全网设置。安全网CCM项目明确地与高风险、高敏度患者合作，适应和培养通常有限的HL水平，并寻求在临床层面改变患者和提供者对HL的要求。因此，对CCM过程和实践的研究可以为HL的概念化和测量提供新的知识，包括将其扩展到组织层面；“现实世界”，为患有不同HL的弱势人群提供护理的可持续战略；以及基于团队的干预措施，成功地促进了HL和患者的参与——患者和家属与提供者合作，在自己的医疗保健中发挥积极作用的能力。因此，这个混合方法项目的具体目标是：(1)提供一个详细、深入的民族志描述，描述CCM项目的相互作用、过程和组织安排，这些项目有助于患者留在临床护理系统中，并满足他们的社会和医疗需求；(2)识别和分析个人（患者和提供者）、项目和组织的特征，这些特征会增强或抑制患者参与和健康素养系统；(3)对人种学数据进行重点分析，以便：a)开发并对患者参与测量工具进行认知测试；确定和详细说明对安全网机构至关重要的组织卫生素养领域和属性；c)阐述一个将组织健康素养属性与患者参与联系起来的概念框架。该项目的总体目标是促进对HL系统的上下文理解；帮助定义和构建组织健康素养的措施，并提高对组织健康素养与患者参与之间关系的理解。

DESCRIPTION (provided by applicant): Research on health literacy (HL) has identified the need for a more complex and nuanced understanding of HL that considers patient HL within a larger context that includes other patient-, provider-, and organization-level dynamics. Recent advances in HL research have begun to investigate the role providers and healthcare systems play in shaping individuals' capacities to meet their health-related needs, and the HL-related demands providers and healthcare systems place on patients. We term this more contextualized conceptualization of HL "health literacy systems," and propose to further our understanding of HL systems through the study of patient- provider-organization interactions, processes, and arrangements that comprise two complex care management (CCM) programs, located in two safety-net institutions. With the Affordable Care Act's coverage of formerly UN- and under W insured populations, we need an extended understanding of HL systems that is applicable to safety net settings where the most vulnerable in our society seek care. Safety-net CCM programs explicitly work with, adapt to, and cultivate the often limited HL levels of their high-risk, high-acuity patients, and seek to change at the clinic level the HL demands placed on patients and providers. Thus a study of CCM processes and practices can contribute new knowledge on the conceptualization and measurement of HL, including its extension to the organizational level; "real world," sustainable strategies to provide care to vulnerable populations with varying HL; and team-based interventions that successfully promote HL and patient engagement-the ability of patients and families to take an active role in their own healthcare in partnership with providers. Therefore, the specific aims of this mixed methods project are to: (1) provide a detailed, in- depth ethnographic description of the interactions, processes, and organizational arrangements of CCM programs that contribute to patients' retention in the clinical care system and fulfillment of their social and medical needs; (2) identiy and analyze individual (patient and provider), program, and organization characteristics that enhance or inhibit patient engagement and health literacy systems; and (3) conduct focused analyses of the ethnographic data to: a) develop and cognitively test a patient engagement measurement tool; b) identify and elaborate organizational health literacy domains and attributes critical for safety net institutions; and c) elaborate a conceptual framework linking organizational health literacy attributes to patient engagement. The overall goals of this project are to advance a contextual understanding of HL systems; help define and construct measures for organizational health literacy and improve understanding of the relationship between organizational health literacy and patient engagement.