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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by contracts between the National Academy of Sciences and the Agency for Healthcare Research and Quality (HHSP233200900537P), Health Resources and Services Administration (HHSH25034004T), American College of Physicians Foundation, Association of Health Insurance Plans, the East Bay Community Foundation; GlaxoSmithKline, Johnson & Johnson, Kaiser Permanente, Merck and Co., Inc., and the Missouri Foundation for Health (09-0290-HL-09). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2011. Improving Health Literacy Within a State: Workshop Summary. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
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The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
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PLANNING COMMITTEE ON UNDERSTANDING WHAT WORKS IN HEALTH LITERACY ACROSS A STATE1
SHARON BARRETTT, Health Literacy Staff Consultant, Association of Clinicians for the Underserved
CAROLYN COCOTAS, Senior Vice President, Quality and Corporate Compliance, F.E.G.S. Health and Human Services
JEAN KRAUSE, Executive Vice President and CEO, American College of Physicians Foundation
RUTH PARKER, Professor of Medicine, Emory University School of Medicine
DEAN SCHILLINGER, Professor of Medicine in Residence, University of California San Francisco
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1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
ROUNDTABLE ON HEALTH LITERACY1
GEORGE ISHAM (Chair), Medical Director and Chief Health Officer, HealthPartners
SHARON E. BARRETT, Health Literacy Staff Consultant, Association of Clinicians for the Underserved
CINDY BRACH, Senior Health Policy Researcher, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality
CAROLYN COCOTAS, Senior Vice President, Quality and Corporate Compliance, F.E.G.S. Health and Human Services System
ARTHUR CULBERT, President and CEO, Health Literacy Missouri
MICHAEL L. DAVIS, Senior Vice President, Human Resources, General Mills, Inc.
BENARD P. DREYER, Professor of Pediatrics, New York University School of Medicine, and Chair, American Academy of Pediatrics Health Literacy Program Advisory Committee
LEONARD EPSTEIN, Senior Advisor, Clinical Quality and Culture, Health Resources and Services
DEBBIE FRITZ, Director, Policy and Standards, Health Management Innovations Division, GlaxoSmithKline
MARTHA GRAGG, Vice President of Program, Missouri Foundation for Health
LINDA HARRIS, Team Leader, Health Communication and eHealth Team, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services
BETSY L. HUMPHREYS, Deputy Director, National Library of Medicine, National Institutes of Health
JEAN KRAUSE, Executive Vice President and CEO, American College of Physicians Foundation
MARGARET LOVELAND, Global Medical Affairs, Merck & Co., Inc.
PATRICK McGARRY, Assistant Division Director, Scientific Activities Division, American Academy of Family Physicians
RUTH PARKER, Professor of Medicine, Emory University School of Medicine
YOLANDA PARTIDA, Director, National Program Office, Hablamos Juntos, University of California, San Francisco, Fresno Center for Medical Education & Research
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1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
CLARENCE PEARSON, Consultant, Globabl Health Leadership and Management
SUSAN PISANO, Director of Communications, America’s Health Insurance Plans
ANDREW PLEASANT, Health Literacy and Research Director, Canyon Ranch Institute
SCOTT C. RATZAN, Vice President, Global Health, Johnson & Johnson
WILL ROSS, Associate Dean for Diversity, Associate Professor of Medicine, Washington University School of Medicine
PAUL M. SCHYVE, Senior Vice President, The Joint Commission
PATRICK WAYTE, Vice President, Marketing and Health Education, American Heart Association
WINSTON F. WONG, Medical Director, Community Benefit, Disparities Improvement and Quality Initiatives, Kaiser Permanente
Study Staff
LYLA M. HERNANDEZ, Staff Director
CHINA DICKERSON, Senior Project Assistant (until December 2, 2010)
ANGELA MARTIN, Senior Project Assistant (beginning November 1, 2010)
ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
Martha Gragg, Medical University of South Carolina
John Gutierrez, University of California Los Angeles School of Dentistry
Lauren McCormack, RTI International
Antronette Yancy, University of California Los Angeles Kaiser Permanente Center for Health Equity
Although the reviewers listed above have provided many constructive comments and suggestions, they did not endorse the final draft of the report before its release. The review of this report was overseen by Harold J. Fallon, Medical University of South Carolina. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteur and the institution.
Acknowledgments
The sponsors of the Institute of Medicine Roundtable on Health Literacy made it possible to plan and conduct the workshop, Understanding What Works in Improving Health Literacy Within a State. Sponsors from the U.S. Department of Health and Human Services are the Agency for Healthcare Research and Quality and the Health Resources and Services Administration. Non-federal sponsorship was provided by the American College of Physicians Foundation; the Association of Health Insurance Plans; the East Bay Community Foundation; GlaxoSmithKline; Johnson & Johnson; Kaiser Permanente; Merck and Co., Inc.; and the Missouri Foundation for Health.
The Roundtable wishes to express its gratitude to the following speakers for their thoughtful and stimulating presentations: Mary Ann Abrams, Ellen Beck, Arthur Culbert, Terry Davis, Ariella Herman, Carol Mangione, Alfred E. Osborne, Jr., Rima Rudd, Dean Schillinger, Pam C. Silberman, Cynthia Solomon, and Eugene Washington. The Roundtable also wishes to express its appreciation to the planning committee for their hard work in putting together an excellent workshop agenda. Members of the planning committee are Sharon Barrett, Carolyn Cocotas, Jean Krause, Ruth Parker, and Dean Schillinger.
Contents
Opening Remarks and Introduction of Keynote Speaker
Overview of the Role of the University in Improving Health Literacy Statewide
3 STATE-BASED MODELS TO IMPROVE HEALTH LITERACY
The Road to Regional Transformation: The North Carolina Experience
The Iowa Experience: Creating a Shared Vision for Health Literacy in Iowa
Louisiana Statewide Health Literacy Initiative
4 THE ROLE OF THE UNIVERSITY IN IMPROVING STATES’ HEALTH LITERACY
How the University Can Advance State Health Literacy
Tables, Figures, and Boxes
TABLES
2-1 Experience of Collaboration in Decision Making, Simulated Model
2-2 Groups Involved in Health Literacy: Definitions
5-1 Parents’ Sources of Help When a Child Is Sick
5-2 Outcomes of 182 Diabetic Patients Seen at the UCSD Free Clinic and Assessed at 1 Year
FIGURES
5-1 HCI health improvement project
5-2 HCI strategic implementation
5-3 Overview of the Head Start intervention
BOXES
3-1 Iowa Health Literacy Sponsors and Their Projects