It was reiterated that a major challenge in this field is finding support to get this work done. People who live in disadvantaged areas have a greater likelihood for bad outcomes in spite of an intervention; providers and the system need to be made aware so that there is a greater likelihood of positive outcomes.

The role of context was again emphasized in terms of implementing quality improvement, health literacy, and health disparities reduction efforts. Context includes the health care system but also the community.

Multiple demands for a more patient-centered health care system are being placed on health care providers, nurses, physicians, and others providing care. But to really transform the system, it is not enough to “work around the edges”; rather, what is needed is to turn the health care system “upside down” so that it really is a patient-centered system.

In closing, it was noted that as a starting point, people need assistance in finding their way through the health care system. Although there are many other reasons to improve health literacy, this is the basic foundation for improvement efforts.