Rapid assessment of health literacy on admission to the hospital

Rapid assessment of health literacy on admission to the hospital H ealth literacy is the measurement of knowledge and skills that a patient needs to make informed medical decisions regarding his or her own medical care or the care of others for which they may be responsible (1). Assessing health literacy has become a point of emphasis for organizations dealing with health care delivery. The impact of low health literacy is widespread (2, 3). Patients with low health literacy often have miscommuni-cation with their health care providers and have an increased rate of hospital admissions (4). They also ask fewer questions (5). Although there have been efforts to educate the public, many feel that some trends in hospitals have made this more challenging, for example, the widespread drift toward shift-oriented hospitalists who typically have no prior association or interaction with the inpatients they are caring for (1). In addition, in a number of settings, poor resident communication skills have been observed (6). A study in the Community Hospital Education and Research Network within the Association of Program Directors in Internal Medicine (APDIM) demonstrated that approaching the issue of health literacy is typically not part of resident patient care competency development (7). A subsequent survey of residents at two community hospitals demonstrated a lack of confidence in assessing health literacy in their inpatient encounters (8). Contributing to this lack of confidence is the status of cultural backgrounds for residents in training at community hospital settings. In typical community hospital medicine residen-cies, the majority of trainees speak English as a second language (ESL). When one is dealing with matters such as medical jargon, acronyms, technical terms, and colloquial abbreviations, it is more difficult for some ESL speakers to identify and communicate with low health literacy patients. Residents can screen for low health literacy with a validated shorthand query. I would advise doing it late in the interview when trust has been developed and when a question about dealing with medical paperwork better fits the context. One simple example used effectively asks 'How confident are you in filling out medical forms by yourself?' (9). High health literacy is not to be overlooked and presents its own framework of challenges. If training residents to adjust to low health literacy patients is a largely unfulfilled part of curricula, training residents and students to recognize and adjust to high health literacy status is even less common. …