- Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Institute of Medicine Report
“Health Literacy: A Prescription to End Confusion”
National Academies Press, 2004
- Communication breakdowns, whether between care providers or between care providers and their patients, is the primary root cause of the nearly 3,000 sentinel events— unexpected deaths and catastrophic injuries—that have been reported to The Joint Commission.
The Joint Commission Sentinel Event Data
www.jointcommission.org
- A large segment of the American population has basic (29 percent) to below basic (14 percent) prose literacy skills.
- An additional five percent are non-literate in English.
- About half of the U.S. adult population has difficulty using text to accomplish everyday tasks.
- The ability of the average American to use numbers is even lower—33 percent have basic and 22 percent have below basic quantitative skills. These skills include the ability to solve one-step arithmetic problems (basic) and simple addition (below basic).
- Most Americans (44 percent) fall into the “intermediate” level of prose literacy. That is, they can apply information from moderately dense text and make simple inferences.
2003 National Assessment of Adult Literacy (NAAL)
National Center for Education Statistics, U.S. Department of Education
- Approximately 21 million people in the U.S. speak English “less than very well.”
U.S. Census Data
- The Joint Commission’s accreditation standards underscore the fundamental right and need for patients to receive information—both orally and written—about their care in a way in which they can understand this information.
The Joint Commission Standards
- Several of the Joint Commission’s National Patient Safety Goals specifically address communication issues.
The Joint Commission National Patient Safety Goals
- People with low health literacy are hospitalized more often and for longer periods of time, use emergency departments more frequently, and, for those with asthma or diabetes, manage their diseases less proficiently.
Institute of Medicine Report
“Health Literacy: A Prescription to End Confusion”
National Academies Press, 2004
- A 2003 study of the rate of errors in medical interpretation conducted by Flores et al found that errors are common and have potentially significant clinical consequences. The study examined 13 pediatric care encounters that involved hospital interpreters, as well as ad hoc interpreters. Ad hoc interpreters included nurses, social workers, and an 11 year-old sibling.
- Each encounter, on average, resulted in 31 interpreter errors.
- The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorializing (10%), and addition (8%).
- Sixty-three percent of all errors had potential clinical consequences.
- These errors were more likely to be committed by ad hoc interpreters (77%) than by hospital interpreters (53%).
“Errors in Medical Interpretation and Their Potential Clinical Consequences”
Flores, Glenn, Laws, M. Barton, Mayo, Sandra J., et al
Pediatrics, 111:1, January 2003: 6-14
- According to a recent study by the Health Research and Educational Trust, 80 percent of hospitals treat patients with Limited English Proficiency (LEP), while only three percent of hospitals receive reimbursement for interpretation services.
AHA News, October 11, 2006
- Fifty-two percent of hospitals report that they collect information on patients’ primary languages to include in their medical records. Only 20 percent collect information about patients’ literacy levels.
Health Research and Educational Trust
- In a recent study of hospital executives’ awareness levels respecting health literacy, 65 percent said that they were aware of the link between low health literacy and medical error; however, only 25 percent rated the issue as a priority that needed to be addressed in their organizations.
The California Health Literacy Institute
“Low Literacy, High Risk: The Hidden Challenge Facing Health Care in California”
October 2003
- In the 2001 Commonwealth Fund Health Care Quality Survey, substantially higher rates of blacks, Hispanics and Asians reported having “communication problems with their physicians” than did white patients. Further, twice as many blacks as whites (16 percent vs. nine percent) reported being treated with disrespect during a health care visit.
“Patient-Centered Communication, Ratings of Care,
And Concordance of Patient and Physician Race”
The Commonwealth Fund, www.cmwf.org/publications