This article, although it never mentions it by name, is talking about the Newest Vital Sign (NVS), developed by Pfizer.  

Every now and then I'll have a physician ask if there are any tools that can be used in the exam room to test a patient's health literacy. I developed a health literacy toolkit for our providers (over 700 physicians across 41 locations) and I included information about assessing health literacy, sticking with the three "biggies" -- REALM, TOFHLA and NVS. Mostly I agree with Dr. Schwartzberg in the article mentioned in the previous post that "this is fine for research" but not always appropriate for clinical practice. I like her quote, "Clinicians can better spend their time ensuring that their patients understand the medical information they need to know to care for themselves."

With that in mind, our online health literacy toolkit for providers includes information about the standard assessments that are available, along with a "fair and balanced" look at the current literature. The NVS assessment, for example, has research that both hails it as a useful tool and criticizes it as a waste of time:

Quick assessment of literacy in primary care: the newest vital sign.
http://www.ncbi.nlm.nih.gov/pubmed/16338915?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Measuring adult literacy in health care: performance of the newest vital sign.
http://www.ncbi.nlm.nih.gov/pubmed/17931135?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

So it depends on who you ask and where you look for your information.

But I'm guessing the AMA is going to conclude that assessing for health literacy in the exam room is not effective and that plain language , coupled with the "teach back method" and short, clearly written handouts should be used with every patient.

And since we're discussing assessment tools, check out these articles (I included them in our health literacy toolkit):

Paasche-Orlow MK, Wolf MS. Evidence does not support clinical screening of literacy. J Gen Intern Med. 2008 Jan;23(1):100-2. Epub 2007 Nov 9. http://www.ncbi.nlm.nih.gov/pubmed/17992564?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Wolf MS, Williams MV, Parker RM, Parikh NS, Nowlan AW, Baker DW. Patients' shame and attitudes toward discussing the results of literacy screening. J Health Commun. 2007 Dec;12(8):721-32. http://www.ncbi.nlm.nih.gov/pubmed/18030638?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

I also thought this article was interesting: One screening question, "How confident are you filling out medical forms by yourself?" was accurate in detecting limited and limited/marginal health literacy skills. 

Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD. Brief report: screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006 Aug;21(8):874-7. http://www.ncbi.nlm.nih.gov/pubmed/16881950?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&dbfrom=pubmed


Doug Seubert
Quality Improvement & Care Management
Family Health Center/Community Heath Access

Marshfield Clinic
1000 N Oak Avenue
Marshfield, WI 54449
www.marshfieldclinic.org/quality

(715) 387-5096 (1-800-782-8581 ext. 75096)
seubert.douglas at marshfieldclinic.org

------Original Message------
From:	"David J. Rosen" <djrosen at comcast.net>
Date:	Tue May 27, 2008 -- 05:06:58 AM
To:	healthliteracy at nifl.gov
Subject:	[HealthLiteracy 2034]  AMA Medical News Article on Health Literacy

Health Literacy Colleagues

I would like to call your attention an article, dated June 2, 2008  
(interesting dateline) in the American Medical news of the
AMA . It poses this question:

Should physicians adjust the communication level for each patient, or  
are comprehension difficulties so common that simpler language should  
be used with everyone?

Doctors are being urged by some researchers to administer  a short  
(on average, just under 3 minutes)  literacy test to their patients  
to increase the doctors' health literacy awareness. Others argue that  
while appropriate for research,  this does not make sense for  
clinical practice. They argue for plain language for all patients.

How many patients are proficient in managing their own medical care?  
One recent study found that

only 12% of adults have the skills to proficiently manage their own  
medical care.

The article mentions that the AMA Foundation will release a report in  
July  on assessing the country's health literacy.

You'll find the article at:

http://www.ama-assn.org/amednews/2008/06/02/hlsd0602.htm


David J. Rosen
djrosen at comcast.net




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