Attachment H -- Project Team Review of Practice HL Environment

Attachment H: Project Team Review of Practice’s

Health Literacy Environment

Demonstration of Health Literacy Universal Precautions Toolkit

A. Project Team Walkthrough of Office

During site visits before and after Toolkit implementation, members of the project team will conduct a walkthrough of each practice to assess the issues identified below.

WAITING ROOM
Observe the waiting room and document the following:
Is the Practice Brochure available at the reception desk?	Yes	No
Does the practice brochure include information to help patients navigate the practice’s system (e.g., phone numbers, who to call for what, who to call after hours)?	Yes	No
Are there other handouts, besides the practice brochure, that the practice distributes to help patients navigate their system?	Yes	No
Are there posters in the waiting room or exam rooms to educate patients about the practice’s phone system?	Yes	No
Are there posters in the waiting room or exam rooms reminding patients to bring their medications to the next visit?	Yes	No
Is information posted on the bulletin board or in exam rooms about the value of medication reviews?	Yes	No
Is information related to the Ask-Me-3, or Questions are the Answer campaigns displayed in the waiting room/exam rooms or provided to patients in some other form?	Yes	No
On the walls and bulletin boards, is posted information organized and useful?	Yes	No
How many separate notices are posted on the bulletin board? ______________________________
Does the office provide health information via closed circuit TV? If so, what type of health information was provided (e.g. focused on common diseases, commercially based/advocating for a product)? ___________________ _______________________________________________ _______________________________________________	Yes	No
Was content provided with subtitles in different languages? What languages? ___________________ _______________________________________________ _______________________________________________	Yes	No
CHECK-IN
Observe 5 patients entering the clinic and document the following:
How many of these patients were given forms to complete? _____________________________________
Of these, how many patients were offered help to complete the forms? _________________________
Of those patients offered help, for how many was help offered in a non-stigmatizing manner (i.e., “Do you need someone to help you fill that out?” is more stigmatizing than “Would you like the nurse to go over that form with you before you see the doctor?”) _________________________
How many of these patients were asked whether they had any questions they wanted to ask their doctor/provider at the visit? ______________________
SIGNAGE
Is the name of the practice clearly displayed on the outside of the building? Or, if a multi-purpose building, are the practice and the clinicians in the practice listed in the building directory located in the lobby?	Yes	No
Are there clearly visible signs directing patients to: Please note instances where signs were not needed due to small size of the practice
practice entrance from the front of the building	Yes	No
waiting room/check-in/check-out area	Yes	No
billing office	Yes	No
laboratory	Yes	No
nursing area or station	Yes	No
bathrooms	Yes	No
Are signs written in multiple languages, such as English and the primary language(s) of the populations being served (e.g., English and Spanish)?	Yes	No
Do signs use everyday language, such as “Walk‐In” and “Health Center,” rather than formal words such as “Ambulatory Care” or “Primary Care Practice?”	Yes	No
Do signs use large, clearly visible lettering?	Yes	No
Are colors or symbols/graphics used to help patients navigate the facility?	Yes	No
CHECK OUT
Observe 5 patients checking out after their visit and document the following:
At check-out, how many of these patients were asked by staff whether they got all of their questions answered at the visit? _______________________________________
How many of the patients who responded that they did not get to ask all of their questions were given the opportunity to talk to someone before leaving the clinic? ______________________________________
At check-out, for how many patients did staff use Teach-Back when discussing appointment times? _____________

B. Project Team Review of Written Materials

To evaluate implementation of Tool 11 (Design Easy-to-Read Material), the project team will collect a sample of patient education materials from each participating practice at pre-test and post-test. We will request that materials be sent to the project team when the practice enrolls in the study (October-December 2012) for the pre-intervention review. Materials will be collected by the site visit teams (July-August 2013) for the post-intervention review.

Materials collected will include the following (although only a sample of these materials may be reviewed depending on the resource-intensiveness of the final evaluation process):

• Practice brochure (if available),

• Patient intake forms, privacy forms, consent to treat forms,

• Appointment slips and reminder cards,

• De-identified or sample test result letters,

• Written patient educational materials (we will request the three most commonly distributed materials),

• Referral forms, and

• Sample of materials available in patient waiting rooms (pamphlets, materials posted on bulletin boards).

We expect to assess readability of written materials using the Patient Health Information Rating System (PHIRS) and/or the Health Literacy Index (HLI).

• The PHIRS, which is due for release no sooner than January 2012, is expected to be capable of evaluating the understandability and actionability of text-based patient education materials.

• The HLI, developed by Matt Kreuter at the University of Missouri, produces a rating that indicates whether written material is easy to read. The Index is expected to be available by the time our assessment of practices’ written materials occurs.

Project Team Review of Practice’s Health Literacy Environments -- Page 9 of 9