for patients with all levels of health literacy skills. Changing health care systems requires more than just looking at the processes of care; the structures of care must also be considered. These structures need to have the ability to deliver better patient care that is better tailored to the individual needs of patients, both on the individual level and the population level.

To improve quality of health care by addressing health literacy and health disparities, the following steps need to be implemented. First, leadership and vision with explicit long- and short-term goals are critical. These goals should relate not only to health care, but also to health care disparities and health literacy. Second, care standards that reduce the existing variation in recommending evidence-based care must be implemented while recognizing that at times, care must also be customized. This involves incorporating the values and preferences of individual patients and considering their individual skills and abilities.

A robust research agenda focusing on health literacy and health disparities is critical to ensure that patient-centered care becomes incorporated as a critical underpinning in all quality improvement efforts. Shared decision-making skills in the health care delivery system are critical, as is the creation and implementation of effective interventions by trained teams with appropriate skills. Quality improvement through disparities reduction and improved health literacy also requires redesigned and optimized care structures and processes, coordinated and integrated care, and effective use of information technologies as a part of process redesign.

It is necessary to create and use performance measures by racial or ethnic group, health literacy capability, and complexity of care interface, as well as to include incentives for improvement of performance measures. Finally, the integration of quality, disparities reduction, and health literacy requires community collaborations with both the public and private sectors.