Since 2003, APHA member Carolyn Clancy, MD, has played a central role in the American health system. As Director of the Agency for Healthcare Research and Quality, Clancy spearheads its mission: “to improve the quality, safety, efficiency and effectiveness of health care for all Americans.” In 2009, Clancy received the William B. Graham Prize for Health Services Research for fostering improved quality of care and reducing health disparities.
In a conversation with APHA’s Public Health Newswire, Clancy talked about the “two-way” conversation needed in health delivery, social media, Healthy People 2020 and how the agency is working with its partners to champion a healthier America.
Q: AHRQ aims to improve health care services for all Americans. What role does communication play in helping the agency achieve its goal?
The main “currency” of health care is communication – and information. Patients seeking care or advice share their personal stories (symptoms, timeline, factors that may precipitate the symptoms, etc) and clinicians then attempt to fit that unique experience with their knowledge of health and disease. AHRQ’s Questions Are The Answer campaign is a good example of how communication can ensure safer care and better health outcomes. The campaign’s public service ads are directed at clinicians with the message that a simple question can reveal as much important information as a medical test. This campaign reminds us all that effective communication between patients and their health care team is important and that it’s possible—even when time is limited.
Communicating the results of research and other AHRQ initiatives is an essential step in the research process. AHRQ’s Office of Communications and Knowledge Transfer ensures that information about Agency-funded research, products, and tools reaches a wide array of target audiences in the most effective ways. Communicating effectively helps patients and clinicians use that information, especially in shared decision making. Research shows that better communication correlates with higher rates of patient compliance with treatment plans. We know that when patients and clinicians communicate well, care is better – especially for people with one or more chronic conditions. But in today’s fast-paced health care system, good communication isn’t always the norm.
Q: You spoke at a health literacy conference in September where you said that 75 percent of medical diagnoses are based “on the story, never mind the tests.” What did you mean by that, and why is it so?
There are a number of studies that confirm that history – the patient’s story – is the most important factor in accurate diagnosis 75 to 80 percent of the time. This phrase means that while tests are invaluable tools, they only tell part of the story. Family and personal medical history, support systems or lack thereof, and other circumstances can help fill in a lot of the blanks in a diagnosis. You need both.
I often give an example of a Spanish-speaking patient who came to the hospital for abdominal pain. With her interpreter (a family friend) present, we asked several times and in different ways if she had symptoms before or had ever taken antacids, but she said no. After her tests came back very abnormal, I actually visited her in her home and saw that she had bottles of antacid everywhere. So even though we had tests and a story, without having both, we didn’t have a clear picture of what was going on with this patient.
Q: Medical interventions emphasize treatment whereas public health is about prevention. Whether it’s vaccinating against flu, reducing obesity or cleaning the air — which communication barriers present the greatest challenge to achieving our public health goals?
Health literacy can be a big communication barrier. The latest AHRQ data show just 12 percent of America’s adults have the skills to understand and evaluate information about their health and health care options so they can make good decisions. People with limited health literacy may not get good results from their health care and that could increase their risks for medical errors. It’s important for health communications materials to reflect different literacy levels. AHRQ supports research to improve health literacy and has funded projects like the development and testing of the Health Literacy Universal Precautions Toolkit. This toolkit is designed to help adult and pediatric practices ensure that systems are in place to promote better understanding by all patients, not just those who are thought to need extra assistance. The toolkit is divided into manageable chunks so that its implementation can fit into the busy day of a practice.
Q: It’s been 10 years since you were appointed director of the Agency for Healthcare Research and Quality. Now, a decade later, what major differences do you see in how we educate Americans about health?
One difference is that we now actively encourage both patients and their health care providers to communicate with one another. Health care used to be a one-sided conversation. But we now know that making the conversation two-sided, and finding ways for patients to be partners in their care is critically important. Questions Are The Answer demonstrates the need for two-way communication. Videos on the AHRQ website feature real patients and clinicians discussing the importance of asking questions and sharing information. Several patients discuss how good communication helped them avoid medication errors or get a correct diagnosis. Clinicians stress the benefits of having their patients prepare for medical appointments by bringing a prioritized list of the questions they wish to cover.
Today, there are also more tools and materials available to patients and we see them bringing in these materials or referencing the Internet during appointments. AHRQ provides resources to help patients prepare before, during, and after their medical appointments with tools like an interactive “Question Builder” that enables patients to create, prioritize, and print a personalized list of questions based on their health condition. We have also created tools to help patients understand diseases and compare treatment options for a variety of different health conditions.
Q: The role of social media and Web messaging continues to grow, which in turn changes the way all health practitioners must communicate with consumers. In what ways has AHRQ embraced the digital world?
We are fairly active on social media. We have had Twitter accounts since 2009. Our main account, @AHRQNews, has almost 15,000 followers ranging from health care professionals to consumers and members of the media. Our main YouTube channel, AHRQHealthTV, has almost 700 subscribers and we have different playlists for audiences interested in patient safety and prevention, as well as both in English and Spanish. We recently launched an AHRQ Facebook page as well (@ahrq.gov) where we communicate AHRQ’s research and tools with consumer-friendly messages. We also feature a podcast series called Healthcare 411 on our website and it is also broadcast to about 2,000 radio stations across the country. Achieving patient-centered care is all about getting valid, reliable information to where patients live, work and play – rather than relying only on information dispenses during a clinical encounter. We really believe that adding these different communication tools helps us reach a wide variety of audiences where they are – and see this as a shared opportunity with our public health colleagues.
Q: A big theme in Healthy People 2020 is reducing disparities: “To achieve health equity, eliminate disparities and improve the health of all groups.” What can APHA and other public health organizations do to help promote health equity?
All Americans should have equal access to high-quality care. Instead, we find that racial and ethnic minorities and people of low socio-economic status often face more barriers to care and receive poorer quality of care when they can get it. The latest National Healthcare Disparities Report that AHRQ released earlier this year verifies that statement. It also shows that minority groups experience rates of preventable hospitalizations that are, in some cases, almost double that of non-Hispanic Whites. Funding research that informs us about these disparities leads to the creation of materials for priority populations that need this information the most.
But promoting and achieving health equity is no easy task. AHRQ recently funded a systematic review of interventions to reduce disparities in health care which reveals more gaps — or opportunities to learn — than off the shelf solutions. This review showed that the collaborative care model — working together with multiple providers to provide care — was associated with improved health outcomes. Likewise, when we work together with organizations such as APHA, who bring together groups concerned about public health issues, we are able to share research, best practices, and lessons learned in an effort to improve health and promote health equity.
To be successful, Healthy People 2020 stresses the importance of agencies and other public health organizations partnering together to expand healthcare access, data collection, and the use of evidence-based interventions. There is an urgent need to test different approaches and learn — rather than waiting for the results of a “definitive” study. Our Effective Health Care program shows how partnerships can work to increase health equity. For example, the Missouri Health Equity Collaborative is partnering with AHRQ’s Effective Health Care Program to promote materials that encourage people to explore their health care treatment options and spread the word across Missouri about the its growing library of free health resources.