The document discusses health literacy as it relates to medication and the use and delivery of healthcare. It analyzes reports from the National Academies of Sciences on these topics. For medication, it describes progress made in standardizing drug labels but notes more is needed. It also discusses using technology like apps and electronic records to promote health literacy. For healthcare delivery, it highlights the importance of health literacy in reducing complexity and disparities. While policies have helped, stronger communication skills are still required. The document proposes a case study on screening for low health literacy using the Newest Vital Sign assessment tool to test hypotheses about time and cost constraints.

1. Dr. Obumneke Amadi-Onuoha_Scripts
Principles/Medical Informatics_ INFR
Case Study: Patient Centered Care Systems, Consumer Health Informatics, and
PHRs
The purpose of this assignment is to access the National Academies website. Find
the “Health Literacy: Past, Present, and Future: Workshop Summary (2015)” report and
provide a two-paragraph summary of the reports: Health Literacy and Medications and
Use and Delivery of Health Care. Also, the assignment requires a case study proposal
based on assignment descriptions.
Health Literacy and Medications
The content of this analysis addressed the progress in the field of health literacy
and medication in three distinct categories: 1) the progress of the field, 2) progress that
has been made creating a standard and best practices for medication prescription labels,
and 3) described the efforts made in the health literacy area. The issue of health literacy
as it applies to medication was frustrating and confusing following the standard patients
obtain prescription, the standard doctors prescribe to patients, the standard pharmacist
give prescribed medication and the standard the pharmacy operates regarding medication
products, other issues investigated was the focus on medication quality, collaboration
between prescribers and users, policies and public behaviors and their struggles towards
understanding and obtaining prescribed medication e.g. drug label. The problem of
variability in medication drug label is overwhelming, regardless the regulated policies
guiding them from the FDA, the result leading to incoordination and confusion such that

2. patients obtain different content from different sources, providers use different terms
even on the same prescription form. Based on these problem researchers sought to
understand the information’s consumers receive from medications labels, what they
extracted and how it was presented to them. The inability to read, interpret and safely
take drugs was identified such that mistakes were common in the number of drugs
patients took, because of low health literacy, therefore there was a need to making drug
information understandable and actionable. In a bid to help correct the issue, some health
care organizations initiative effort to provide recommendations towards a more patients
friendly drug labels e.g. CVS and Target and Veterans Health Administration, helped
designing standard drug labels with selection of information that is often confusing to
patients. Also, the FDA approved a new regulation requiring all prescription drugs have
a single, standardized Patient Medication Information (PMI) document, and that patient
receives only a piece of paper for all prescription received after pharmacy encounter
(National Academies of Sciences, Engineering, and Medicine, 2015, pp. 11-26). Other
drug safety measure is also in progress or established already that include addressing
issues related to demographic subgroups in clinical trials data collection, reporting, and
analysis, that may be of benefit to physicians and consumers who use the data to
diagnose, self-treat, and self-manage the condition being treated. In addition, use of
technology, with an app such as electronic health record has been implemented as a
support to promote health literacy in patients. Finally, the paper demonstrated there is a
need for consumers to treat themselves, however, the need to do it safely is a complex
margin. Also, though there has been progressing made to solve the problem, greater

3. progress is needed to solve the issues of health literacy and medication safety (National
Academies of Sciences, Engineering, and Medicine, 2015, pp. 11-26).
Use and Delivery of Health Care
Over the past decade, concepts of health literacy have been incorporated into the
use and delivery of healthcare. This advancement has been noted demonstrated as a
progress towards a commitment to creating a system that cares about the patient’s safety.
One important aspect of health literacy is its relation to access, use and delivery of health
care, because it serves as a link between the individuals(patients) and system(providers),
thereby supporting: increase in equity, addressing of disparity, promoting patient-
centeredness, improving outcomes and quality, and reducing health care costs. To
promote health literacy in use and delivery of care, it is important to have effective
communication, based on this, concepts of universal precautions were implemented to
address certain needs, through training and education, they include: 1) to assist clinician
in practicing their assignment, 2) to support for patients, families, and social networks to
understand and use health care efficiently. Also, while health literacy has helped reduce
the complexity of communication use and health care delivery with patients and
providers, through implemented policies, yet, there is a greater need for stronger policies
that would demonstrate the communication skills needed to confirm health literacy
understanding. To delivering care, it is important to understand the quality of health
improvement by focusing on the systems, process, and how they impact individual
patients e.g. available resources: people, infrastructure, materials, information,
technology, and others, and, to confirm what is done with those resources, how they are
used, and impact of the services delivered/satisfaction of patients (National Academies of

4. Sciences, Engineering, and Medicine, 2015, pp. 27-49). However, better care is an asset
of quality of health improvement cultured from health literacy, that is focused on the
national quality strategy by Affordable Care Act (ACA) aimed at better , affordable,
accessible, & safe care, while improving population health, and addressing health
disparities in the communities. Making health literacy a priority by the public,
government would promote greater improvement in health care delivery and health for
all, with efforts that include: developing, disseminate health and safety information and
use of evidence-based health literacy practices and intervention and many others.
Another, action towards better health delivery in health enrollment process is to create
outreach programs, an in-person collaborative assistance to help vulnerable population
and patients to navigate through obtaining health care services e.g. (in health insurance
enrollment), most importantly to be aware that health literacy is an issue in different ways
for different populations and different geographies(National Academies of Sciences,
Engineering, and Medicine, 2015, pp. 27-49).
How Should Health Literary Be Taken into Consideration
From my understanding of patient-centered care systems, health literary should be
taken into consideration through understanding the psychosocial and environmental
aspect relating to the – population(age), different geographies(language) and the
education (providers training, patient understanding) in health care system.
Health Literacy by population(age): Health literacy as we already know is the
ability to read and understand health information. The capability for a patient to process
disease or treatment information once received by either the care giver, provider or
patient is vital in health care delivery that helps to facilitate informed and appropriate

5. health decision making. According to the National Assessment of Adult Literacy, older
adults ages 65 and older have a low proficient level of health literacy that can affect their
ability to understand and adequately act upon health information (Duffy, 2018). Children
and older adults are at higher risk of poor measurable health outcomes e.g. they ask fewer
questions about their medical treatment, therefore, there is a need for providers to
effectively educate and evaluate their patients towards a proper understanding of what is
required for their adequate health care delivery and care (Duffy,2018). It is also, crucial
to recognize and adapt to a patient’s level of health literacy to promote the effectiveness
of the patient's encounter.
Health Literacy by different geographies(language): empowering patients through
patient centered care focusing on their geographical attribute of language would precisely
create a flexible and community-based care with the strong health care delivery system
and care support. It is important to emphasize on the language used on materials that
relay health information to patients, e.g. Engel (2018), a study that reviewed the
treatment literacy material for TB patient reveled that most analyses of treatment literacy
materials were limited to English language, this problem may limit the support from
patients towards building a comprehensive and patient centered health care delivery.
Health Literacy by education (providers training, patient understanding): low
health literacy is one of the social determinants of health disparities. It is important that
health organizations measure the health literacy education for the providers and patients
through training to reduce communication barriers between consumers and providers.
The capability of a provider and patient to understand materials to ensure they adhere to
the guideline is critical in care delivery and patient safety, e.g. “Teach-back training

6. incorporated into staff educational activities, including orientation, annual competencies,
grand rounds, skills labs, refresher sessions, and elective courses” (Simmons, et al., 2017)
would advance health systems into becoming health literate organizations, including
consumers-patients’.
Finally, knowing the patient is essential when providing patient-centered care.
Two elements that facilitate knowing are continuity of care and clinical expertise. It is
essential for providers to make a clinical judgment, decision making, and the
personalizing of care. Also, “professional practice models that intentionally support
providers relationship with patients may maximize providers contributions to patient
outcomes” (Zolnierek, 2014, p. 6).
Case Study Proposal
The case study I propose is an example of an application that supports patient
centered care or improved health literacy. The research idea is one published in the
scientific literature and cites accordingly. The case study includes:
a. Proposal/Definition of the Problem
Limited health literacy has been identified as a risk factor for many
adverse health outcomes that include, underuse of preventive services,
diagnosis, and increased hospitalizations. The time, costs, and clinical
utilization of screening have posed difficulties in identifying and caring for
the patients with limited health literacy. The study explored the business
and clinical cases for screening for health literacy using the Newest Vital
Sign (NVS) (Welch, VanGeest & Caskey, 2011).
b. SuggestedHypothesis

7. Time, cost constraints, clinical screening for health literacy in primary
care are associated with implementing NVS screening (Welch, VanGeest
& Caskey, 2011).
c. Description of Biomedical Informatics Intervention/Program
To explore the costs associated with health literacy screening in a primary
care clinic as well as preliminary data on clinicians’ utilization of patients’
health literacy data related to the same case study using the Newest Vital
Sign (NVS). The NVS consists of a nutritional label accompanied by 6
questions that assess both the patient’s reading and numeracy skills
(Welch, VanGeest & Caskey, 2011).
d. Methods to test the hypothesis
Data were collected in 2008 in the Morehouse School of Medicine
Department of Family Medicine Primary Care Clinic. Health literacy
screening was implemented as part of routine intake procedures within an
ongoing quality improvement effort to improve cardiovascular disease and
diabetes outcomes. The time requirements, administrative and training
costs, and clinician utilization associated with the NVS was monitored
(Welch, VanGeest & Caskey, 2011).
e. Results/Support of hypothesis testing
The outcome identified, only small time and cost constraints associated
with implementing NVS screening. Clinical utility was more problematic,
however, because refresher training was needed to ensure continued staff
and clinician buy-in, use of the NVS data and implementation of best

8. practices to communicate with at-risk patients (Welch, VanGeest &
Caskey, 2011).
Reference
Duffy, M. (2018). Addressing Varying Levels of Health Literacy Among Age 65 and
Older Type 2 Diabetic Patients in a Rural Primary Care Setting: A Quality
Improvement Project.
Engel, N. (2018). Towards patient-centred care: analysing TB treatment literacy
documents and adherence discourses. The International Journal of Tuberculosis
and Lung Disease, 22(3), 238-238.
National Academies of Sciences, Engineering, and Medicine. (2015). Chapter’s 3 and 4:
Health literacy: Past, present, and future: Workshop summary. National
Academies Press.
Welch, V. L., VanGeest, J. B., & Caskey, R. (2011). Time, costs, and clinical utilization
of screening for health literacy: a case study using the Newest Vital Sign (NVS)
instrument. The Journal of the American Board of Family Medicine, 24(3), 281-
289
Simmons, R. A., Cosgrove, S. C., Romney, M. C., Plumb, J. D., Brawer, R. O., Gonzalez,
E. T., & Moore, B. S. (2017). Health literacy: cancer prevention strategies for
early adults. American journal of preventive medicine, 53(3), S73-S77.
Shortliffe, E. H., & Cimino, J. J. (2014). Chapters 12 and 21: Biomedical informatics:

9. Computer applications in health care and biomedicine. 3rd edition. Springer,
ISBN 0-387-28986-0
Zolnierek, Cynthia Diamond,PhD., R.N. (2014). An integrative review of knowing the
patient. Journal of Nursing Scholarship 46, (1) (01): 3-10,
http://proxygw.wrlc.org/login?url=https://search-proquest-
com.proxygw.wrlc.org/docview/1537382609?accountid=11243 (accessed
September 18, 2018).