Advances in Health Literacy

2007 Conference Home Speakers Executive Summary

Co-Sponsored by the Institute of Medicine
November 28, 2007

Speakers

David W. Baker, MD, MPH
Health Literacy and Mortality Among Elderly Persons
Dr. Baker is Michael A. Gertz Professor in Medicine, Chief of the Division of General Internal Medicine, and Associate Director of the Institute for Healthcare Studies at the Feinberg School of Medicine, Northwestern University. He received his MD from the UCLA School of Medicine and his MPH from the UCLA School of Public Health. He completed his research training in the UCLA Robert Wood Johnson Clinical Scholars' Program.

His research has focused on access to health care, racial and ethnic disparities in care, health communication, and quality of care for chronic diseases. In the area of access to care and health care delivery for vulnerable populations, his interests include health literacy, language barriers, the effect of lack of insurance on health care use and health outcomes, and racial and ethnic differences in health care use and outcomes. He was Principal Investigator for the Literacy in Health Care Study, the first study of the prevalence of inadequate health literacy, and Principal Investigator for the Prudential Health Literacy Study, the largest study ever conducted of the relationship between literacy, health status, and use of health care services. He conducted one of the largest studies of health outcomes for the uninsured among a national sample of adults in late middle-age. He served on the Institute of Medicine's Subcommittee on Community Effects of Uninsured Populations. His research currently is examining the relationship between literacy and mortality among the elderly, the relationship between literacy and medication errors, and methods to improve patient education and health communication with patients who have limited literacy.

In the area of quality of care, he served as the Associate Project Director for the AHCPR-funded Heart Failure guideline and was lead author for a series of manuscripts in JAMA on quality of care for patients with heart failure. He has served as an advisor to both the Ohio and the Georgia Peer Review Organizations' heart failure quality improvement projects, and he was part of the American Heart Association's working group for measuring quality of care and outcomes for cardiovascular disease. He served on the American College of Cardiology/American Heart Association Heart Failure Practice Guideline committee and the American Board of Internal Medicine's Committee for their new Heart Failure Practice Improvement Module. He has led studies examining many aspects of quality, including whether hospital mortality "report cards" lead to changes in market share for hospitals and improvements in outcomes, the effect of disease management programs for patients with heart failure, and an evaluation of the Institute for Healthcare Improvement's Improving Chronic Illness Care Collaborative. His current work is examining quality measurement and quality improvement using electronic health record systems.

Michael S. Barr, MD, MBA, FACP
Health Literacy for Doctors: How to Use Physician Practices to Help Patients Understand Health Information
Dr. Barr is Vice President, Practice Advocacy and Improvement for the American College of Physicians. Dr. Barr's focus is on public policy relating to the patient-centered medical home, quality improvement, practice redesign, and health information technology. He has overall responsibility for the College's Regulatory and Insurer Affairs Department, Practice Management Center, and Medical Laboratory Evaluation Program. Dr. Barr also directs the College's grant-funded Center for Practice Innovation.

Prior to joining the ACP staff in February 2005, Dr. Barr served as the Chief Medical Officer for Baltimore Medical System, Inc. (BMS), a Joint Commission accredited, multi-site federally-qualified community health center from 1999 - 2005. Dr. Barr was on faculty in the Division of General Internal Medicine at Vanderbilt University from 1993 - 1998 and held various administrative positions including Physician Director, Medical Management Programs for the Vanderbilt Medical Group. Dr. Barr served in the United States Air Force from 1989 - 1993 at Moody Air Force Base, Georgia.

Dr. Barr completed his residency in Internal Medicine at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois. He is a graduate of New York University School of Medicine, the Vanderbilt Owen Graduate School of Management, and the State University of New York, College of Environmental Science and Forestry. Dr. Barr continues to see patients part-time at the George Washington University Medical Faculty Associates urgent care clinic and holds part-time faculty appointments at Johns Hopkins University and George Washington University.

Terry C. Davis, PhD
The American College of Physicians Foundation Diabetes Guide: How We Did It and Why It Works
Dr. Davis is a pioneer in the field of health literacy. She is Professor of Medicine and Pediatrics at Louisiana State University Health Sciences Center in Shreveport, LA (LSUHSC-S), where she also heads the Behavioral Science Unit of the Feist-Weiller Cancer Center. For the past 20 years, she has led an interdisciplinary team investigating the impact of patient literacy on health and healthcare. Seminal achievements include development of the Rapid Estimate of Adult Literacy in Medicine (REALM), the most widely used literacy test in health care settings, and production of video tapes that have personalized the problem of low health literacy.

Dr. Davis chaired Louisiana's statewide Health Literacy Task Force, the first legislatively mandated health literacy group in the nation. She currently serves on the master faculty of the AMA's Train-the-Trainer Health Literacy Curriculum, is a member of the Healthy People 2010 Health Literacy/Health Communication Section, and the FDA's Drug Safety and Risk Management Advisory Committee.

Dr. Davis has published more than ninety articles and book chapters related to health literacy, health communication, and preventive medicine. As director of the Doctor/Patient Communication course at LSUHSC and as a frequent speaker at national conferences, she has integrated her research findings into practical lessons for medical students and residents, as well as practicing physicians, pharmacists, and nurses.

Dr. Davis, together with investigators at the University of North Carolina and the University of California at San Francisco, developed and tested a diabetes self-management guide funded by the American College of Physicians Foundation (ACP-F), which has distributed more than 400,000 copies to our nation's physicians. She was recently awarded NIH funding for a five-year Health Literacy Intervention to improve cancer screening in Louisiana Federally Qualified Health Clinics. She is also currently working with faculty at Northwestern University and Emory to improve patient comprehension of medication labels. This research has received significant media notice in The New York Times, USA Today, NPR, CBS, ABC, and the BBC.

Darren DeWalt, MD, MPH
Moderator - Health Literacy Research in Specific Populations
Dr. DeWalt is assistant professor in the division of general internal medicine at the University of North Carolina at Chapel Hill. He is board-certified in pediatrics and in internal medicine.

Dr. DeWalt actively researches self-management interventions for patients with low-literacy and focuses on chronic diseases like diabetes, heart failure, COPD, and asthma. He was a member of the RTI-UNC Evidence-based Practice Center scientific team which performed a systematic review of the impact of literacy on health outcomes for the Agency for Healthcare Research and Quality and wrote the chapter in the AMA Textbook on Health Literacy regarding the relationship between literacy and health outcomes.

Dr. DeWalt led the design team and is currently the director of evaluation for the Improving Performance in Practice (IPIP) program funded by the Robert Wood Johnson Foundation. IPIP is a program to help practicing primary care physicians improve care systems through working in improvement networks, measuring and sharing performance data, and receiving improvement education and training.

Dr. DeWalt is the principal investigator at the UNC research site for the Patient Reported Outcomes Measurement Information System (PROMIS). PROMIS is developing advanced tools for measurement of symptoms, function, and quality of life. Dr. DeWalt is interested in the use of self-report measurements among vulnerable populations, particularly those with low literacy.

Dr. DeWalt is a former Robert Wood Johnson Clinical Scholar at the University of North Carolina at Chapel Hill. He completed his residency in internal medicine and pediatrics at the University of North Carolina at Chapel Hill where he also served as chief resident in internal medicine. He received his medical degree from the Vanderbilt University School of Medicine.

Harold J. Fallon, MD, MACP
Introductions and Opening Remarks
Dr. Fallon is the former Home Secretary of the Institute of Medicine. Prior to this he served as Dean of the University of Alabama, School of Medicine and Associate Dean for Graduate Medical Education. Dr. Fallon was also the Vice Chair of Medicine at UNC and later Chairman of Medicine at MCV in Richmond until 1992. His major clinical interests as well as clinical research interests have focused on liver diseases. He helped to found liver sections at the University of North Carolina and the Medical College of Virginia and supported the development of the Liver Center at the University of Alabama. He graduated from Yale Medical School in 1957 and was an intern and resident in Internal Medicine at the University of North Carolina in Chapel Hill. He was a Clinical Associate at the National Cancer Institute of the NIH 1959-1961.

Dr. Fallon has been a member of numerous academic societies, especially in Internal Medicine and Hepatology. He is past President of the Southern Society for Clinical Investigation, Vice President of the American Society for Clinical Investigation, President of the American Association of Physicians, Chairman of the American Board of Internal Medicine, Chairman of the Board of Regents of the American College of Physicians, Chairman of the Residency Review Committee in Internal Medicine, and President of the American Association for the Study of Liver Disease. Dr. Fallon has served on various editorial boards of scientific publications. He was elected to the Institute of Medicine of the National Academy of Sciences in 1989. He was a member of the Membership Committee and its Chairman from 1995 through 1998.

George J. Isham, MD, MS
What Needs to be Done to Introduce Change in Health Literacy
Dr. Isham is the Plan Medical Director and Chief Health Officer at HealthPartners. Dr. Isham is responsible for quality, utilization management, health promotion and disease prevention, research, and health professionals' education at HealthPartners. He is a founding board member of the Institute for Clinical Systems Improvement, a collaborative of Twin Cities medical groups and health plans that is implementing clinical practice guidelines in Minnesota. Dr. Isham is a past member of the board of directors of the American Association of Health Plans and he is currently on the board of directors of the Alliance of Community Health Plans. He is past co-chair and current member of National Committee for Quality Assurance's (NCQA) Committee on Performance Measurement which oversees the Health Plan Employer Data and Information Set quality measurement standard. He is chair of the American Diabetes Association/NCQA Committee on Provider Recognition which oversees the Diabetes Provider Recognition Program. He has served on the CDC's Task Force on Community Preventive Services and on Agency for Healthcare Research and Quality's (AHRQ) Advisory Board for the National Guideline Clearinghouse. He serves on the Institute of Medicines' Board of Health Promotion and Disease Prevention. Dr. Isham chaired the Institute of Medicine's committee that authored the report Priority Areas for National Action, Transforming Health Care Quality. Epidemic of Care, published in April 2003, with co-author George Halvorson, is Dr. Isham's examination of the impending health care crisis with suggestions on ways to solve it. Prior to his current position, Dr. Isham was medical director for MedCenters Health Plan in Minneapolis and executive director for University Health Care, Inc., in Madison, Wisconsin. His practice experience as a primary care physician included eight years at the Freeport Clinic in Freeport, Illinois, and three and one-half years as clinical assistant professor in Medicine at the University of Wisconsin.

Dr. Isham's educational background includes: a Bachelor of Arts in Zoology and Master of Science in preventive medicine/administrative medicine from the University of Wisconsin Madison; Doctor of Medicine from the University of Illinois; and an internship and residency in internal medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.

Rose Marie Martinez, ScD
The Institute of Medicine's Roundtable on Health Literacy
Ms. Martinez is the Director of the Institute of Medicine's (IOM) Board on Population Health and Public Health Practice (1999- ). The Board has a vibrant portfolio of studies that address high profile and cutting edge issues that affect the public's health. The Board addresses the science base for public health interventions and examines the capacity of the health system, particularly the public health infrastructure, to support disease prevention and health promotion activities, including the education and supply of health professionals necessary for carrying them out. The Board has examined such topics as the safety of childhood vaccines, pandemic influenza preparedness, the revival of civilian immunization against smallpox, the health effect of environmental exposures, the capacity of governmental public health departments to respond to health crises; Americans' use of complementary and alternative medicine, the soundness and ethical conduct of clinical trials to reduce maternal to child transmission of HIV/AIDS, among others.

Prior to joining the IOM, Dr. Martinez was a Senior Health Researcher at Mathematica Policy Research (1995-1999) where she conducted research on the impact of health system change on the public health infrastructure, access to care for vulnerable populations, managed care, and the health care workforce.

Dr. Martinez is a former Assistant Director for Health Financing and Policy with the U.S. General Accounting Office where she directed evaluations and policy analysis in the area of national and public health issues (1988-1995). Her experience also includes six years directing research studies for the Regional Health Ministry of Madrid, Spain (1982-1988).

Dr. Martinez received the degree of Doctor of Science from the Johns Hopkins School of Hygiene and Public Health.

Daniel Morrow, PhD
Collaborative Aids for Provider/Patient Self-Care Planning
Dr. Morrow is associate professor at the University of Illinois at Urbana-Champaign with appointments in the Human Factors Division (Institute of Aviation) and the Beckman Institute for Advanced Science and Technology. He received a PhD in cognitive psychology from the University of California Berkeley, followed by a postdoctoral fellowship at Stanford University where he conducted research on text comprehension. After his post-doc, he was involved in research at Stanford University School of Medicine and NASA-Ames Research Center related to language comprehension in complex real world tasks, focusing on pilot-controller communication. His current research interests include the impact of age-related differences in cognitive function on communication, and designing environments to support older adults' competence in health care and aviation domains. He has been funded by NIH to develop communication strategies that support older adults' self-care (medication adherence and appointment attendance), and to investigate relationships between expertise and aging in pilot performance. He has served on the editorial boards of Discourse Processes, Psychology and Aging, and Journal of Experimental Psychology: Applied. In 2006 he was the Pfizer Visiting Professor in Health Communication at the University of North Carolina.

Elyse Barbell Rudolph
Literacy Community Centers and Health Literacy
Ms. Rudolph has been Executive Director of the Literacy Assistance Center since 2001. For the past 20 years, the LAC has been New York's pre-eminent provider of free professional development, technical assistance, and support for adult literacy education programs. The LAC now manages the statewide student record-keeping system, hosts the statewide multilingual literacy hotline, and welcomes the adult literacy community to its computer-learning center and the city's largest resource library for literacy teachers. In partnership with the Altman Foundation, The New York Times Foundation, and the NYC Department of Youth and Community Development, the LAC founded the Immigrant Family Literacy Alliance, which has raised nearly $1 million in new private funding for New York City literacy programs.

Under Ms. Rudolph's leadership the LAC has begun offering its services to nonprofit organizations and agencies outside the adult education community that serve similar constituencies. These have included hospitals and clinics, legal services agencies, and public schools. The highly effective innovations of the health literacy initiative, developed in collaboration with the Harvard School of Public Health, have won national recognition. In the past two years more than two dozen health care institutions and organizations have benefited from LAC services, including the New York City Health and Hospitals Corporation, United Way, Montefiore Medical Center, and New York Presbyterian Medical Center.

Ms. Rudolph's publications have included Job Hunting Skills for Lifelong Success (Learning Express, Random House); Building Literacy through Child Development, with Dr. Arlene Martin (Kendall Hunt); Adult Education Guide to Using the New York Times, with Diane Rosenthal (New York Times), and Using the Daily News in the Adult Education Classroom (Daily News).

Ms. Rudolph has worked at Kean/Montclair State and Brooklyn College. She has facilitated dozens of workshops at the LAC and other organizations and conferences, on topics ranging from adult basic education to using visual cues to enhance comprehension.

Ms. Rudolph holds a B.A. from Hofstra University and Certificate in the Leadership Development Program of the Columbia University School of Not for Profit Management.

Lisa Sanders, MD
Health Literacy and the Media
Dr. Sanders is an Assistant Clinical Professor at the Yale University School of Medicine and a clinician educator in Yale's Primary Care Internal Medicine Residency program. In her research and practice, she specializes in the treatment of overweight and obese patients. She is the author of The Perfect Fit Diet: How to Lose Weight, Keep it Off And Still Eat the Foods You Love. Dr. Sanders writes the popular "Diagnosis" column which appears monthly in The New York Times Magazine. She serves as a technical advisor on the popular Fox television show "House M.D." Before entering medical school, Sanders was an Emmy Award-winning producer at CBS News, where she covered medicine and health. She is currently working on a book, based on her columns, on how doctors make diagnoses.

Barbara L. Schuster, MD, MACP
Moderator - New Topics in Health Literacy Research

Dr. Schuster is a Robert G. Petersdorf Scholar-in-Residence at the Association of American Medical Colleges (AAMC) after stepping down from the position of Professor and Chair of the Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio. She completed her B.A. in biology and a M.S. in Science Education at the University of Pennsylvania in 1972. After a year teaching in a public high school, she returned to medical school completing her M.D. at the University of Rochester in 1977. Dr. Schuster completed her residency in Internal Medicine in the Associated Hospitals Program in Rochester, New York and then served on the faculty of the University of Rochester until 1995. Prior to her move to Dayton, Ohio, she held the positions of residency program director for the Primary Care Program in Internal Medicine and the Combined Internal Medicine/Pediatrics Program.

Dr. Schuster is the immediate past President of the Association of Professors of Medicine (APM). She served as the Chair of the Council of Academic Societies (CAS) of the AAMC in 2003-04 and served six years on the Executive Council of the AAMC. Dr. Schuster is actively involved in the American College of Physicians. As a Regent from 1999 through 2005, she served on the Recertification Committee, the Nominations Committee, was the 1999 to 2000 Chair of the Awards Committee, and from 2001 to 2005 was Chair of the ACP Education Committee. She is currently the Chair of the ACP Foundation Programs Committee and a member of the ACPF Program Planning Subcommittee.

Angelo E. Volandes, MD
Health Literacy Not Race Predicts End-of-Life Care Preferences
Dr. Volandes is faculty member in the General Medicine Unit at the Massachusetts General Hospital and Harvard Medical School. He received his BA in philosophy from Harvard College and his medical degree form the Yale School of Medicine. Following medical school, Dr. Volandes completed a residency in internal medicine at the University of Pennsylvania. He then completed fellowships in medical ethics at Harvard Medical School and Brigham and Women's Hospital. He was named the Edmond J. Safra Faculty Fellow in 2004-5 at the Safra Center for Ethics at Harvard University.

Dr. Volandes was the Principal Investigator on a recently published study in the Archives of Internal Medicine on the use of video images of dementia in advance care planning (video available). He is currently the PI of a project that compares the effect of a video decision aid of dementia to verbal descriptions on the medical decision making of elderly patients with dementia.

Dr. Volandes' research is focused on empirical philosophical analyses of contemporary ethical issues in medicine. His interests include medical decision-making, Alzheimer's disease, health literacy, health inequalities at the end of life, genetic enhancements, pre-natal genetic diagnosis and theoretical frameworks for medical ethics. His work has also appeared in the American Journal of Bioethics, the Journal of Clinical Ethics and the Journal of Medical Ethics. He has also produced and directed a film documentary on the patient-doctor relationship, Illness As Experience. (Film clip available).

H. Grady Watts
Using Media to Improve Cardiovascular Disease Self-Management
Mr. Watts is currently the Senior Vice President for State of the Art, Inc. Prior to this, he was President of Grady Watts Productions, Inc. and Co-Director of the Washington Community Video Center.

Mr. Watts produced, directed and/or wrote the following:

"Men and Depression," 2003-2007, funded by the National Institute of Mental Health (PI: Watts). Scheduled for PBS release early in 2008
"Self-Management of Cardiovascular Disease," 2004-2005, funded by the National Heart, Lung and Blood Institute
"Well Into Your Future: Mental Health and Aging," 2003-2004, funded by the National Institute of Mental Health (PI: Watts) 3-part series aired on PBS in 2004-2005
"Now Is Our Time: Healthy Living for Women 40-55," 2003, funded by National Institute of Nursing Research
"Graduating Peter" - Theatrical Release, HBO Broadcast and Video, 2003, funded by Home Box Office
"Positively: Mental Health and HIV/AIDS," 2002, funded by the National Institute of Mental Health
"Home Care: A National Campaign," 2000, funded by the National Institute of Mental Health
"Prostate Cancer: A National Campaign," 1999, funded by the National Cancer Institute
"What's Best For You: Families Living with HIV Talk about Disclosure," 1994, funded by FXB Center, formerly the National Pediatric HIV Resource Center
"Educating Peter" - Theatrical Release, HBO Broadcast and Video, 1992, funded by Home Box Office

Mr. Watts has been a principal investigator and published several peer-reviewed publications several organizations. Some of which include "Raising Awareness about Elderly Suicide," 2003, which was funded by the National Institute of Mental Health and "Arthritis Education Campaign: Pain and Exercise," 2003, which was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases

Mr. Watts has a Masters in Arts from Stanford University and a Bachelors of Arts from Harvard University.

Alastair J.J. Wood, MD, FACP
Simplifying Medication Scheduling - Can We Confuse Patients Less?
Dr. Wood is managing Director of Symphony Capital LLC; a New York based private equity company managing over $300 million dedicated to investments in the clinical development of novel biopharmaceutical products.

Dr. Wood received his medical degree from St Andrew's University and Dundee Medical School in Scotland. He joined the Faculty at Vanderbilt University School of Medicine in 1978 where he became tenured Professor of both Medicine and Pharmacology and Attending Physician at Vanderbilt Medical School. He was Assistant Vice Chancellor for Clinical Research (1999-2004), and Associate Dean, Vanderbilt Medical School (2004-2006) before being appointed Emeritus Professor of Medicine and Emeritus Professor of Pharmacology in 2006. His current academic appointments are Professor of Medicine and Professor of Pharmacology at Weill Cornell Medical College, New York.

Dr. Wood is a member of many societies and has received numerous honors, notably election to membership of The Institute of Medicine of The National Academy of Sciences, The American Association of Physicians (AAP), The American Society for Clinical Investigation (ASCI), Honorary Fellow, American Gynecological and Obstetrical Society (AGOS), Fellowship of The American College of Physicians, Fellowship of The Royal College of Physicians of London, and Fellowship of The Royal College of Physicians of Edinburgh. He was the 2005 recipient of the Rawls-Palmer Award in recognition of "Drug investigation that brings the effects of modern drug research to the care of patients" from the American Society for Pharmacology and Therapeutics.

Dr. Wood has served on a number of Editorial Boards. He was a member of The New England Journal of Medicine Editorial Board (2004-2006); he was the Drug Therapy Editor of The New England Journal of Medicine from 1985 to 2004, and is also on the Editorial Board of Clinical Pharmacology and Therapeutics. He has previously served on the Editorial Boards of The British Journal of Clinical Pharmacology and Biopharmaceutics and Drug Disposition. He authored the Chapter in Harrison's Principles of Internal Medicine on Adverse Drug Reactions from the 9th through the 15th edition.

Dr. Wood was the chairman of the FDA's Nonprescription Drugs Advisory Committee until 2006, and chaired the 2005 FDA Advisory Committee on Cox-2 inhibitors. He previously served as a member of the Cardiovascular and Renal Advisory Committee of the Food and Drug Administration, and the FDA's Nonprescription Drugs Advisory Committee. Dr. Wood has also been both a member, and has chaired NIH Study Sections, and has served in a similar capacity for various philanthropic grant-giving bodies. He has served as a director of pharmaceutical companies including Antigenics (AGEN), Symphony Neurodevelopment, and Symphony Evolution. He has also served as a consultant to pharmaceutical companies, investors and academic institutions. He has provided Congressional testimony, and directly interacted with and advised senior White House officials, legislators, and the Secretary of Health on matters related to public health. He is a frequent commentator in the national press on issues related to medicine and pharmaceuticals.

His research interests have been focused on understanding the mechanisms for interindividual variability in drug response, with a particular focus on the molecular genetics of adrenergic receptors, ethnic differences in drug response, vascular response, and the genetics of drug metabolism. His research has been continuously funded by NIH, and has resulted in over 280 articles, reviews and editorials.

Hsiang Shonna Yin, MD
Use of Low Literacy Pictogram-based Intervention to Reduce Medical Errors in Low Socioeconomic Status (SES), Low Education Families: A Randomized Controlled Trial
Dr. Yin is a Board-certified Pediatrician and Instructor at NYU School of Medicine/Bellevue Hospital Center in New York City. Her primary research projects focus on improving provider-parent communication of medical instructions. She is co-Principal Investigator of a project to assess whether medication counseling which incorporates plain language, pictogram-based written materials can reduce medication errors and improve adherence. Dr. Yin is also studying the link between parent health literacy and outpatient medication administration errors, as well as the impact of parent health literacy on issues such as utilization of care and preventive health. She collaborates with a multidisciplinary group of educators, providers, families, and community organizations, through Bellevue Hospital's Health Education and Literacy for Parents (HELP) project, a program to assist low literacy, limited English proficient parents of young children in understanding health information.

Dr. Yin received her Bachelor's degree in Biology from the Massachusetts Institute of Technology and obtained her medical degree from the University of Rochester. After completing an internship and residency in Pediatrics at the NYU School of Medicine, she was accepted to the CDC/NYU Medicine and Public Health Research Fellowship program, where she earned a Masters of Science degree in Clinical Research. Dr. Yin was recently awarded the 2007 Pfizer Fellowship in Health Literacy / Clear Health Communication.