Factors associated with utilisation of health care interpreting services and the impact on length of stay and cost: A retrospective cohort analysis of audit data.

ISSUE ADDRESSED: Utilisation of professional health care interpreting services improves the quality and safety of health care among patients with limited English proficiency. Health care interpreter service utilisation is inconsistent and suboptimal in Australia. Evidence of the impact of interpreter service use on patient outcomes and costs is limited. This study aimed to identify the proportion of hospitalised patients who received a health care interpreter during admission and describe the characteristics and outcomes for those requiring interpreter services. METHODS: A retrospective cohort analysis of linked admitted patient data with internal interpreter audit data. This study included all inpatients in a health district-wide clinical audit of interpreter service use conducted between July 2016 and March 2018. The dataset comprised 74 patients (including 79 unique hospital stays and 90 episodes) from eight hospitals in one regional health district in New South Wales, Australia. RESULTS: Interpreting services were utilised at least once for 54.4% (n = 43) of admissions. Females were more likely to receive an interpreter (65.1% vs 47.1%, P = .04). Age, preferred language, hospital, Diagnosis-Related Group partition and comorbidities were not associated with interpreter service utilisation. Differences in length of stay and cost associated with use of interpreter services were not statistically significant after casemix adjustment. CONCLUSIONS: Approximately half of those who required an interpreter received one during their hospital stay. Further investigation is needed to establish whether regular clinical audits contributed to this rate of utilisation, which is higher than reported elsewhere in the literature. SO WHAT?: A detailed understanding of regional interpreting service use with evidence from the literature provides compelling and contextual evidence for change, at the level at which the service is delivered. This supports meaningful action to increase utilisation, and improve the quality and safety of health care delivered to patients with limited English proficiency.

Implementation of an organisation-wide health literacy approach to improve the understandability and actionability of patient information and education materials: A pre-post effectiveness study.

OBJECTIVE: Limited examples exist globally of coordinated, organisation-wide health literacy approaches to systematically improve the understandability and actionability of patient health information. Even fewer have been formally evaluated. The aim of this study was to use the Patient Education Materials Assessment Tool (PEMAT) to evaluate the effectiveness of an organisation-wide, evidence-based approach to improve the understandability and actionability of patient information materials in regional health service in New South Wales, Australia. METHODS: Two independent raters (blinded to the document version) evaluated pre- and post-implementation versions of 50 randomly-selected patient information materials using the PEMAT, with differences in understandability and actionability analysed using paired samples tests. RESULTS: Mean (±SD) overall scores for understandability increased significantly by 5% (95% CI 2-8; p = 0.002) up to 77%±10%, and mean actionability (±SD) increased significantly by 4% (95% CI 0-8; p = 0.046) up to 56%±22%. CONCLUSION: These results demonstrate that organisation-wide approaches with standardised processes for staff to prepare, review and store written patient information and education materials can be successfully implemented to address the impacts and risks of low health literacy. PRACTICE IMPLICATIONS: The success of this approach provides a framework for other health organisations to work in partnership with patients to make health information more understandable and actionable.

Embedding health literacy into health systems: a case study of a regional health service.

Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them. Currently, only 40% of consumers in Australia have the health literacy skills needed to understand everyday health information to effectively access and use health services. What does this paper add? Addressing health literacy in a coordinated way has the potential to increase safety and quality of care. This paper outlines the practical and sustainable actions the Illawarra Shoalhaven Local Health District took to partner with consumers to address health literacy and to improve the health experience and health outcomes of consumers. Embedding health literacy into public health services requires a coordinated whole-of-organisation approach; it requires the integration of leadership and governance, revision of consumer health information and revision of consumer and staff processes to effect change and support the delivery of health-literate healthcare services. What are the implications for practitioners? Embedding health literacy into health systems promotes equitable, safe and quality healthcare. Practitioners in a health-literate environment adopt consumer-centred communication and care strategies, provide information in a way that is easy to understand and follow and involve consumers and their families in decisions regarding and management of the consumer's care.