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Hospital Readmission Penalties Loom But HeLP is on the way

by Ronald Collins, M.S.
chris davis

Does this scenario sound familiar? Mr. Thompson, a 64-year-old pneumonia patient, leaves the hospital with his daughter after a three-day stay. She drops Dad off at home, confident he is on the road to recovery. Six days later, Mr. Thompson is back in the ER with a persistent cough and a fever of 102 degrees. Diagnosis: recurrent pneumonia.

Unfortunately, this mock scenario is a daily reality in our healthcare system. According to research, most seniors say they feel overwhelmed by the hospital environment, and want, more than anything, to go home. Many falsely claim they understand how to take care of themselves to gain release, and some wind up back in the hospital.

That's very bad news for hospitals facing stiff financial penalties for readmitting patients within 30 days of discharge. Currently, this penalty only applies to three conditions: heart failure, heart attack and pneumonia. In the future, however, the list of conditions will increase – and so will the financial penalties.

The health literacy crisis

chris davis

Health literacy is "the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."1

Low health literacy is a very widespread problem, spanning all educational and socio-economic levels. In 2003, the U.S. Institute of Educational Sciences reported that 36% of U.S. adults had limited health literacy. This situation at the point of care is not much better, with evidence showing "patients often misinterpret or do not understand much of the information given to them by clinicians."2 Put another way: even if the mythical Mr. Thompson was listening to his caregiver, he probably wouldn't have understood him.

The cost of doing nothing

The economic impact of low health literacy is estimated to be between $106 billion and $328 billion each year, accounting for 7% to 17% of all personal healthcare expenditures.3 Aside from the tremendous financial waste, those figures represent incalculable human suffering, providing both a fiscal and moral imperative for correcting this problem.

HeLP 4 Patients

chris davis

The stark figures above, combined with new mandates, have forced hospitals to examine their practices, and invent new strategies for improving the discharge process.

One innovative example comes from Gwinnett Medical Center near Atlanta, Georgia. Patient and Family Education Coordinator Lynne Sycamore works with health literacy company Nucleus Medical Media to develop a simple, effective approach for educating patients at the point of care and at home.

The concept is branded "HeLP 4 Patients", which stands for "Health Literacy Pathway for Patients", a four-step health literacy process designed to reduce preventable readmissions due to improper self-care.

Gwinnett Medical Center uses HeLP 4 Patients process in conjunction with its health literacy website, "Caring for Yourself After Surgery". Nurses access the website to show patients narrated animations on topics with a high rate of preventable complications, including caring for surgical drains, removing Foley catheters, checking blood flow to areas after surgery, and using crutches.

The animations are suitable for a 5th to 8th grade listening audience. To serve the local patient population, they are translated into Spanish and Korean.

"Our goals are to improve patient satisfaction and health outcomes," said Ms. Sycamore, explaining the HeLP 4 Patients process.

"First, our staff shows patients the discharge animations in the hospital, and follows it up with a teach-back session. We discover what questions they have, and ask patients to explain the content in their own words. Afterward, patients receive an illustrated handout with a link to the website so they can review the material at home."

chris davis

open quote The economic impact of low health literacy is estimated to be between $106 billion and $328 billion each year. end quote

Sycamore believes this process, and especially the narrated animations, will help patients when they get back home.

"When patients leave our care, they're still feeling the effects of anesthesia, or they may be on pain medication. Patients may not remember everything we've told them. If they prefer the paper form, they can follow those instructions, and if they need more direction, they can go back to the website and watch the animations again," she says.

To view Gwinnett's website, go to gwinnettmedicalcenter.nucleuslibrary.com or contact Nucleus Medical Media at [email protected].

1. 2004, Health Literacy: A Prescription to End Confusion, Nielsen-Bohlman, et. al. 2. 2007, American Medical Association, Weiss 3. 2003, NAAL Health Literacy Survey, Vernon, et. al.
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