A Criteria for Evaluating Patient Education in the Rural FQHC Setting

Submitter Information

Author: Alexandra G. Thompson, MSN, BSN, BA, FNP-C, APRN, RN
Title: Family Nurse Practitioner
Institution: MedLink Georgia / Emory University
Email: sashathompson@att.net
Coauthors: Nicole R. Powell, DNP, MSN, BSN, FNP-BC, APRN, NP-C, RN-C

Competency Category(s)
Evidence-Based Practice, Patient-Centered Care, Quality Improvement

Learner Level(s)
Advanced Practice Providers, Interprofessional, New Graduates/Transition to Practice

Learner Setting(s)
Clinical Setting

Strategy Type
General Strategy

Learning Objectives

Knowledge:
Integrate understanding of multiple dimensions of patient-centered care (information, communication, and education; patient/family/community preferences, values)
Examine common barriers to the active involvement of patients in their own health care processes
Discuss principles of effective communication
Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families
Describe approaches for changing processes of care

Skills:
Provides patient-centered care with sensitivity and respect for the diversity of human experience
Assess the level of patient’s decisional conflict and provide access to resources
Use the criteria for quality improvement efforts
Seek information about outcomes of care for populations served in a care setting
Identify gaps between local and best practice
Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Study-Act)
Use measures to evaluate the effect of change

Attitudes:
Respect and encourage the individual expression of patient values, preferences, and expressed needs
Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals
Appreciate how unwanted variation affects care
Value measurement and its role in good patient care
Appreciate the value of what individuals and teams can do to improve care

Strategy Overview

While providing care for patients at a rural federally qualified health center (FQHC) in the Southeast, a lack of available education meeting the specific needs of the facility’s patient population was identified. In order to identify the population’s priority needs, local and regional literacy data were reviewed and compared to the available national data to identify facility-specific literacy needs. In addition to consideration of population literacy, contemporary definitions of cultural humility and sensitivity to resource limitations serve as the foundational concepts upon which the criteria were developed. Finally, we sought to enhance access to education for multilingual populations that could be integrated into a high volume, primary care workflow.

In order to develop the criteria, we reviewed the evaluation process and guidelines followed by other organizations in the development and distribution of patient education. The criteria were derived from researching several professional organizations and their review processes. Consulted sources include the Agency for Healthcare Research and Quality, the Maine Health health literacy programs, and the Centers for Disease Controls and Prevention Clear Communication Index tool. The recommendation provided to the quality improvement committee at our organization was to utilize the developed criteria to evaluate existing resources as well as updates to patient education. Further, the criteria for submission and review of evidence-based research followed by our specialty practice authorities were reviewed and adapted to the time and practice limitations of the facility’s providers. Quality improvement in the area of patient education serves as the primary purpose of the resulting criteria.

Submitted Materials

300-2-QSEN-Education-Criteria-Sample.pdf
300-3-QSEN-Submission-References.pdf

Additional Materials

Interested parties may contact authors for additional files or patient education examples.
We are willing to share the criteria as well as the patient education files that were utilized. Preferred contact via email.

Evaluation Description

In order to assess the existing patient education utilized by the providers at the organization, the most commonly used education was identified by a sample survey of approximately fifteen providers and correlated with a list of the most common diagnoses billed within the organization.

The developed criteria were used to evaluate the existing patient education for the most common diagnoses. The process showed that none of the existing patient education met the criteria for utilization. The existing patient education lacked transparency regarding source of information, date last reviewed, cultural humility, and known literacy level. As a result, a search for patient education for most utilized diagnoses was undertaken. Additionally, the new patient education needed to be easily accessible in multiple languages to providers working in a high volume, primary care setting. The new patient education was then evaluated with the developed criteria and selected for inclusion in a computer-based file shared with other providers via the organization’s shared drive. Implementation of the new patient education in the clinic setting is currently in progress with patient and provider feedback results pending.

The recommended process for implementation includes the following steps:
– Survey clinical staff about most used patient education documents
– Evaluate the most used patient education documents using the criteria
– Acquire new evidence-based patient education documents for existing documents not meeting the criteria
– Apply criteria to a selection of patient education documents to be used in the implementation of a pilot program
– Disseminate education during a select time period at pilot centers within the organization
– Survey patients’ regarding their experience related to receiving the education
– Compile data from all pilot centers to present to a Quality Improvement team
– Review data with key stakeholders to create a large-scale implementation plan
– Establish a committee to continue the process of reviewing and disseminating patient education documents

Ideally, three or five people comprise the committee, and ongoing evaluation by the committee may be undertaken using the PDSA model.