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Novant Health, a not-for-profit integrated system of 15 medical centers and 1,123 doctors in 343 clinic locations, has a goal of becoming a health-literate organization. Thanks to AHRQ's Health Literacy Universal Precautions Toolkit, the four-state health system is well on its way. Based in Winston-Salem, NC, Novant Health has implemented vital pieces of the toolkit at its hospitals and ambulatory clinics over the last three years with measureable success.

Now, Novant Health—the nation's fifth largest medical group—is rolling out the toolkit into its 150 primary care clinics. More than 90 percent of the system's primary care clinics are patient-centered medical homes.

"You can't be a patient-centered medical home unless you are a health-literate organization," says Tom Bauer, M.B.A., Novant Health's corporate director of voice and choice. He adds that the toolkit is the primary resource Novant Health is using to educate its 24,400 employees and physician partners about health literacy. "The toolkit provides a trusted, easy-to-use, best practice resource that health care organizations can use for health literacy."   

More than a third of U.S. adults have limited health literacy, which interferes with their ability to take care of their health. The result is in increased hospitalizations and poor health outcomes. Health care providers, however, often can't identify which patients have limited health literacy. AHRQ's toolkit helps provider organizations take "universal precautions" to minimize risk for all patients.

"The toolkit has everything you need," Mr. Bauer notes, including the philosophy behind it, the assessment, and the tools. "It is not a buckshot approach; it is a laser-targeted approach. And it allows you to adapt it to your organization."    

Although the toolkit was designed to help primary care practices promote better understanding by all patients, Novant Health first adapted parts of the toolkit to implement into its hospitals and other facilities. It used "The Teach-Back Method" (Tool 5), to tackle spoken communication shortfalls, as well as tools to simplify language and written materials. It also used the National Patient Safety Foundation's Ask Me 3â„¢.

"Why is teach-back so important? According to research conducted at the University of Minnesota, up to 80 percent of what is shared is forgotten immediately, and up to half of what is shared is recalled incorrectly," says Mr. Bauer.

The teach-back method confirms patients' understanding of what their provider has explained, in a non-shaming way, by asking patients to describe in their own words what they need to know or do. The method calls for providers to reteach the patient, if necessary.

A study of 250 patients conducted by Novant Health's Stroke Center found a 78 percent increase in patients' understanding of the importance of their treatment plan from pretest to after the teach-back and Ask Me 3 methods were implemented. Patients also significantly better understood their diagnoses and their treatment plan after the intervention.

Heart failure patients at the system's Presbyterian Medical Center were given a test to assess whether they had the knowledge necessary to manage their condition. "The average score was 38.5 percent" for those patients before the intervention, Mr. Bauer says. "Once Ask Me 3 and teach-back were implemented, the average score rose to 85 percent and has held for over two years."

The increase in understanding contributed to a 44 percent decrease in hospital readmissions at Presbyterian for congestive heart failure patients, he said, adding that "patient satisfaction jumped in all of the demonstration sites."

In the spring of 2013, Novant Health began rolling out AHRQ's Health Literacy Universal Precautions Toolkit into its primary care practices. "The toolkit is designed for the primary care practice," says Lynn Bergman, Novant Health's director of patient-centered care. "We really value the toolkit approach." She says the toolkit supports the health literacy and patient engagement aspects of the patient-centered medical home approach.

In early 2014, Novant Health reorganized its system into medical neighborhoods, with multidisciplinary care teams supporting the primary and specialty care clinics assigned to a hospital. Novant Health is again adapting its use of the toolkit to support the system's reorganization.

For example, Novant is working with its information technology department to make the toolkit's assessment easily accessible to care providers. The assessment helps to "focus" providers, Mr. Bauer says, adding that the system is using health literacy to "ground continuous quality improvement."

To learn more about the toolkit, visit ´óÏóAPPHealth Literacy Universal Precautions Toolkit.