Health literacy a cornerstone of quality pediatric care
- Copyright © 2011 by the American Academy of Pediatrics
Nearly 90% of English-speaking adults have limited health literacy skills, according to the 2003 National Assessment of Adult Literacy. This lack of capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions is a key determinant of our nation’s inability to achieve health equity — an AAP universal principle. As a result, we’ve targeted health literacy as a key component of quality care for pediatric patients and families within a medical home.
To that end and in response to a resolution passed by the 2004 Annual Leadership Forum, the Academy has focused on providing pediatricians and families with health literacy tools to improve communication about managing health and illness. An AAP Health Literacy Project Advisory Committee (PAC) was established to head up these efforts.
Led by Mary Ann Abrams, M.D., M.P.H., FAAP, and Benard Dreyer, M.D., FAAP, the PAC developed plain-language handouts for common pediatric conditions, organized a national research conference on the topic and published a 2009 supplement to Pediatrics. It also published a comprehensive health literacy resource for practicing pediatricians, Plain Language Pediatrics: Health Literacy Strategies and Communication Resources for Common Pediatric Topics.
Other AAP resources designed to help pediatricians and families navigate increasingly complex clinical information include:
Bright Futures Tool and Resource Kit,
PediaLink health literacy module,
HealthyChildren.org consumer Web site, and
professional and lay publications, including Spanish for Pediatric Medicine: A Practical Communication Guide.
First, we can expect the volume of information and “opinion” available to children and families will continue to proliferate. Advice from pediatricians is a small fraction of the consumer information universe. If the Academy is to support the entire scope of health literacy as defined by the Institute of Medicine, we must continue to focus on empowering children and their families to be health literate so they can lead healthy lives.
Second, reforming health care into more effective and (cost) efficient medical homes, accountable care organizations and other integrated care delivery systems will place expectations on pediatricians to deliver care that “bends the cost curve” and saves resources. This may be challenging for pediatricians accustomed to focusing on health, wellness, growth and development.
Health literacy interventions, however, are beginning to demonstrate improvement in modifying adult health behaviors and chronic disease management. This potentially is an area where pediatricians can actually reduce expenses. Care coordination, a cornerstone of cost-efficient and outcome-driven care management in medical homes and other integrated care models, is heavily influenced by health literacy. Some authorities point out that 95% of successful care management and care coordination is due to active, informed patient and caregiver involvement in these processes.
A third focus will be implementation. In November 2010, the Academy, American Medical Association and American Dental Association convened a forum on Healthcare Professions Implementing the National Action Plan to Improve Health Literacy. Along with U.S. Department of Health and Human Services Assistant Secretary for Health Howard Koh, M.D., M.P.H., and representatives from 10 other national health associations, the forum focused on how best to accomplish the seven goals of the national health literacy action plan. I’m pleased to report the AAP already has several implementation initiatives under way:
The Culturally Effective Care Toolkit, to be released this year on Practice Management Online, has a section on health literacy improvement practice strategies.
Helping Babies Breathe, although not directly targeted to health literacy, offers a powerful example of a straightforward approach to dramatically improve outcomes in resource-limited areas. The approach may deserve further consideration in other health care delivery venues.
The 2012 Pediatrics for the 21st Century Symposium will focus on health equity, including health disparities and health literacy.
The AAP is committed to optimal health and well-being for all infants, children, adolescents and young adults. We’re also committed to being a leader in the promotion of health literacy. Assuring that all families are able to access and understand the information they need to pursue the right care, in the right place, at the right time and in the right manner is critical to the pursuit of that mission.