Measuring Health Literacy: What, So What, Now What?

Ruth M. Parker, M.D.Professor of MedicineEmory University School of Medicine

What?

• H.L. is fundamental to health reform, timely

• H.L. reflects dual nature of communication

• “What gets measured gets done”... Cocotas

Health Literacy Framework

So What?

• Individual—used to describe prevalence/associations (last 15 years) REALM, TOFHLA

• Community —geo-coding map

• Population - NAAL

Measures ofSkills and Ability

300 studies - health material demand exceeds ability

CAHPS and HCAHPS – under development

? What are the essential skills across life-span for successfully navigating/ engaging in health?

? Do health systems reflect health literacy within organizational infra-structure?

Measures of Demands/Complexity

Not Aligned

Closer look…pill bottle label

Skills/Ability Demands/Complexity

Back to Cocotas…

What gets measured gets done….

Putting health literacy on the agenda builds demand for measurement and action.

Organizational Infra-structure…where is health literacy?

HealthPartners (George)

PILL (AHRQ/RWJF)

Health plan audit tool (AHIP/RWJF)

? The Medical Home - What is the infrastructure for a health literate medical home?

Now What?

What do we want? (n=1) response…

• Broad agreement that h.l. occurs when skills/ability are aligned with demands/ complexity

• Measures reflect dual nature▫ Goal is for all to “be” health literate▫ Indicators reflect progress toward goal of

aligning skills with demand

• HHS -- create ongoing national data repository of health literacy skills/ability

• HHS -- make available tract level data map of entire country detailing skills/ability

• In clinical practice, promote “universal precautions” rather than individual skill testing

Measures ofSkills and Ability

• CMS and health plans develop meaningful metrics of “health literate” care and service providers• models, demonstrations• incentives for early adopters

• NIH, professional societies define essential “need to know to do” for health. Be clear, use baby steps.

Demands/Complexity

Measure it…“what gets measured gets done”

• Incorporate health literacy into HP 2020• Link to national efforts to measure health

quality, disparities, and cost