Table 2.

Consensus Organizational Health Literacy Quality Improvement Measures

Consensus Measure Number, Title, and Description	Measure Source,a Data Source, Measure Computation Specifications, and Health Care Settingb	Psychometric Testing and National Endorsement
OHL Domain: Organizational Structure, Policy, & Leadership
Measurement theme: Leadership support for organizational health literacy activities
Number: CM-1 Title: Leadership Support of Health Literacy Efforts Description: Percentage of leaders who attended health literacy awareness activity	Measure source: Health care organization Data source: Process data collected by implementation staff Numerator: Number of members of the organization's senior leadership (e.g., medical director, chief executive officer, nursing manager) who attend health literacy awareness activity Denominator: Number of members of the organization's senior leadership Setting: Measure is relevant across settings	None identified
Measurement theme: Staffing and structures to enhance patient and family engagement
Number: CM-2 Title: PFE Hospital Evaluation Metric 3—PFE Leader or Functional Areac Description: Hospital has a person or functional area, who may also operate within other roles in the hospital, that is dedicated and proactively responsible for Patient & Family Engagement and systematically evaluates PFE activities (i.e., open chart policy, PFE trainings, establishment and dissemination of PFE goals)	Measure source: American Institutes for Research (2016) Data source: Organization leadership (e.g., chief quality officer, vice president for patient experience) can report whether policy exists Computation: Measure assesses whether the organization has a person or unit that is responsible for initiating and evaluating patient and family-engagement activities Setting: Designed for hospitals, but relevant across settings	The Centers for Medicare & Medicaid Services uses this measure as 1 of 5 metrics aimed at supporting efforts to improve PFE (American Institutes for Research, 2016). We were unable to identify prior psychometric testing
Measurement theme: Structured methods for encouraging PFE
Number: CM-3 Title: PFE Hospital Evaluation Metric 4-Patient and Family Advisory Council or Representative on Quality Improvement Teamc Description: Hospital has an active Patient and Family Engagement Committee (PFEC) or at least one former patient that serves on a patient safety or quality improvement committee or team	Measure source: American Institutes for Research (2016) Data source: Organization leadership (e.g., chief quality officer, vice president for patient experience) can report whether policy exists Computation: Measure assesses whether the organization (1) has a PFE Committee or (2) involves at least one former patient on a patient safety or quality improvement committee Setting: Designed for hospitals, but relevant across settings	The Centers for Medicare & Medicaid Services uses this measure as 1 of 5 metrics aimed at supporting efforts to improve PFE (American Institutes for Research, 2016). We were unable to identify prior psychometric testing
Number: CM-4 Title: PFE Hospital Evaluation Metric 5 – Patient(s) and Family on Hospital Governing and/or Leadership Boardc Description: Hospital has at least one or more patient(s) who serve on a Governing and/or Leadership Board and serves as a patient representative	Measure source: American Institutes for Research (2016) Data source: Organization leadership (e.g., chief quality officer, vice president for patient experience) can report whether policy exists Computation: Measure assesses whether the organization has at least one patient serving as a representative on the organization's governing or leadership board Setting: Designed for hospitals, but relevant across settings	The Centers for Medicare & Medicaid Services uses this measure as 1 of 5 metrics aimed at supporting efforts to improve PFE (American Institutes for Research, 2016). We were unable to identify prior psychometric testing
OHL Domain: Communication
Measurement theme: Serving patients with limited English proficiency
Number: CM-5 Title: Screening for Preferred Spoken Language for Health Care Description: Percentage of hospital admissions, visits to the emergency department, and outpatient visits for which preferred spoken language for health care is identified and recorded	Measure source: National Quality Forum (2012f) Data source: Claims data, electronic health record/medical chart Numerator: Number of hospital admissions, visits to the emergency department, and outpatient visits during which patient's preferred spoken language for health care is identified and recorded Denominator: Number of hospital admissions, visits to the emergency department, and outpatient visits Setting: Hospitals and other inpatient facilities, and urgent care	This measure has shown evidence of face and construct validity (National Quality Forum, 2012b) and has been incorporated into the Agency for Healthcare Research and Quality's National Measures Clearinghouse. Although the measure received initial endorsement by the National Quality Forum (Measure 1824 L1A), endorsement was removed in April 2017 (National Quality Forum, n.d.). According to J. Tilly of the National Quality Forum (personal communication, June 28, 2018), endorsement was removed because the Measure Steward was longer interested in maintaining the measure, not due to concerns over the measure's scientific acceptability
Number: CM-6 Title: Patients Receiving Language Services Supported by Qualified Language Services Providers Description: Percentage of patients who state a preference to receive spoken health care in a language other than English who have documentation in their electronic health record that they received initial assessment and discharge instructions supported by trained and assessed interpreters or bilingual providers, workers, or employees assessed for language proficiency	Measure source: National Quality Forum (2012f) Data source: Electronic health record/medical chart Numerator: Number of patients with limited English proficiency for whom the electronic health record documents that the patient received initial assessment and discharge instructions supported by trained and assessed interpreters or from bilingual providers, workers, or employees assessed for language proficiency Denominator: Number of patients who stated a preference to receive spoken health care in a language other than English Exclusions: Patients who state a preference to receive spoken health care in English, leave without being seen, or leave against medical advice prior to initial assessment Setting: Hospitals and other inpatient facilities, and urgent care	This measure has shown evidence of face and construct validity (National Quality Forum, 2012b) and has been incorporated into the Agency for Healthcare Research and Quality's National Measures Clearinghouse. Although the measure received initial endorsement by the National Quality Forum (Measure 1821 L2), endorsement was removed in April 2017 (National Quality Forum, n.d.). According to J. Tilly of the National Quality Forum (personal communication, June 28, 2018), endorsement was removed because the Measure Steward was no longer interested in maintaining the measure, not due to concerns over the measure's scientific acceptability
Number: CM-7 Title: Patients Receiving Language Services During Consent Discussions Description: Percentage of informed consent discussions for patients with limited English proficiency that have documentedinvolvement of an interpreter	Measure source: Health care organization Data source: Electronic health record/medical chart Numerator: Number of patients with limited English proficiency for whom the consent discussion involved an interpreter Denominator: Number of patients with limited English proficiency who had an informed consent discussion Setting: Measure is relevant across settings	None identified
Measurement theme: Using the Teach-Back method to ensure patient comprehension
Number: CM-8 Title: Staff Trained to Use Teach Back Description: Percentage of staff who report being formally trained to use the Teach-Back method	Measure source: Health care organization Data source: Staff survey item: “Have you been formally trained to use the Teach-Back technique?” Response Options: yes, partially, no Numerator: Number of staff members who answer “yes” when asked if they have received formal training in using the Teach-Back method Denominator: Number of staff who completed the staff survey Setting: Measure is relevant across settings	None identified
Number: CM-9 Title: Patients Correctly Teaching Back Discharge Instructions Description: Percentage of discharged patients who correctly taught back discharge instructions	Measure source: Health care organization Data source: Electronic health record/medical chart Numerator: Number of patients for whom the electronic health record documents that Teach Back was conducted and that the patient was able to correctly teach back discharge instructions Denominator: Number of patients discharged Setting: Hospitals and other inpatient facilities	None identified
Measurement theme: Medication review to improve accuracy and patient understanding
Number: CM-10 Title: Care for Older Adults – Medication Review Description: Percentage of adults 66 years and older who had a medication review	Measure source: National Quality Forum (2010) Data source: Electronic health record/medical chart Numerator: Number of patients with at least one medication review conducted by a prescribing practitioner or clinical pharmacist during the measurement year and the presence of a medication list in the medical record Denominator: All patients age 66 years and older as of December 31 of the measurement year Setting: Hospitals and other inpatient facilities, ambulatory care, post-acute care	This measure has shown strong evidence of reliability (National Quality Forum, 2012a) and has been endorsed by the National Quality Forum (Measure 0553) since August 2009 (National Quality Forum, n.d.)
OHL Domain: Ease of Navigation
Measurement theme: Simplifying the process of scheduling appointments
Number: CM-11 Title: Follow-up Appointment Scheduling Description: Percentage of patients who get follow-up appointments made upon discharge	Measure source: Health care organization Data source: Electronic health record/medical chart Numerator: Number of patients for whom a follow-up appointment is made prior to discharge Denominators: Number of patients discharged Setting: Hospitals and other inpatient facilities	None identified
Measurement theme: Ensuring referral completion
Number: CM-12 Title: Referral Report Received Description: Number of patients with a referral for whom the referring provider received a follow-up report from the provider to whom the patient was referred	Measure source: Health care organization Data source: Electronic health record/medical chart Computation: Number of patients with a referral for whom the referring provider received a follow-up report describing the results of the referral visit Setting: Ambulatory care, health systems	None identified
OHL Domain: Patient Engagement & Self-Management Support
Measurement theme: Improving access to patient education
Number: CM-13 Title: Inpatient Education Received Description: Percentage of inpatients given patient education on bedside tablet who complete the education module	Measure source: Health care organization Data source: Electronic health record/medical chart or process data collected by implementation staff Numerator: Number of inpatients who complete patient education using bedside tablet Denominator: Number of inpatients offered patient education using bedside tablet Setting: Hospitals and other inpatient facilities	None identified
Measurement theme: Addressing patients' nonmedical needs
Number: CM-14 Title: Screening for Nonmedical Needs Description: Percentage of patients screened for nonmedical needs	Measure source: Health care organization Data source: Electronic health record/medical chart Numerator: Number of patients screened for nonmedical needs (e.g., housing, transportation, food assistance) Denominator: Number of patients Setting: Measure is relevant across settings	None identified
Number: CM-15 Title: Referral for Nonmedical Needs Description: Percentage of patients who screened positive for needing nonmedical support who were referred for services	Measure source: Health care organization Data source: Electronic health record/medical chart Numerator: Number of patients referred for nonmedical services (e.g., housing, transportation, food assistance) Denominator: Number of patients who “screened positive” for having nonmedical needs Setting: Measure is relevant across settings	None identified
Measurement theme: Setting self-management goals
Number: CM-16 Title: Self-Management Goals Description: Percentage of patients with diabetes who have set a self-management goal	Measure source: Health care organization Data source: Electronic health record/medical chart Numerator: Number of patients with diabetes who have a self-management goal documented in the electronic health record or medical chart Denominator: Number of patients with diabetes Setting: Ambulatory care	None identified
Measurement theme: Self-management support before, during, and after an inpatient stay
Number: CM-17 Title: PFE Hospital Evaluation Metric 1—Planning Checklist for Scheduled Admissions Description: Prior to admission, hospital staff provide and discuss a discharge-planning checklist with every patient who has a scheduled admission, allowing for questions or comments from the patient or family (e.g., a planning checklist that is similar to the Centers for Medicare & Medicaid Service's Discharge Planning Checklist)	Measure source: American Institutes for Research (2016) Data source: Organization leadership (e.g., chief quality officer, vice president for patient experience, director of nursing) can report whether policy exists Computation: Measure assesses whether the organization has a policy to review a discharge-planning checklist with all patients prior to admission Setting: Designed for hospitals, but relevant across inpatient settings	The Centers for Medicare & Medicaid Services uses this measure as 1 of 5 metrics aimed at supporting efforts to improve PFE (American Institutes for Research, 2016). We were unable to identify prior psychometric testing
Number: CM-18 Title: PFE Hospital Evaluation Metric 2—Shift Change Huddles/Bedside Reporting Description: Hospital conducts shift change huddles for staff and does bedside reporting with patients and family members in all feasible cases	Measure source: American Institutes for Research (2016) Data source: Organization leadership (e.g., chief quality officer, vice president for patient experience, director of nursing) can report whether policy exists Computation: Measure assesses whether the organization has a policy to conduct shift change huddles for staff and bedside reporting with patients and families Setting: Designed for hospitals, but relevant across inpatient settings	The Centers for Medicare & Medicaid Services uses this measure as 1 of 5 metrics aimed at supporting efforts to improve PFE (American Institutes for Research, 2016). We were unable to identify prior psychometric testing
Number: CM-19 Title: Postdischarge Phone Call Description: Percentage of discharged patients for whom postdischarge phone call was completed	Measure source: Auerbach et al. (2014) Data source: Electronic health record/medical chart Numerator: Number of discharged patients who received a postdischarge phone call Denominator: Number of discharged patients who were supposed to receive a postdischarge phone call Setting: Hospitals and other inpatient facilities, and urgent care	None identified
Measures that cut across domains
Number: CM-20 Title: Health Literate Health Care Organization-10 (HLHO-10) Score Description: Computed score based on hospital administrator's responses to 10 questions designed to assess the 10 attributes of a health literate health care organization	Measure source: Kowalski et al. (2015) Data source: Survey of Hospital Administrator (Kowalski et al., 2015) Computation: Administrator responds to 10 questions using a 7-point scale ranging from not at all(1) to to a very large extent(7). The overall score is the mean score across the 10 items Setting: Hospitals	Survey tested with 51 German hospitals and found to have strong internal consistency reliability (α = 0.89) and to significantly predict breast cancer patients' perceptions of the adequacy of health information received (Kowalski et al., 2015)
Number: CM-21 Title: Health Literate Discharge Score Description: Computed score based on staff responses to 36 questions addressing language preferences/needs, communication regarding needed follow-up appointments, medication review, readability of written care plan, patient education, and follow-up after discharge	Measure source: Innis, Barnsley, Berta, & Daniel (2017) Data source: Staff Survey (Innis et al., 2017) Computation: Staff respond to 36 questions using a 5-point Likert scale. For each respondent, the mean score across items is computed. The overall score is the mean score across respondents (range, 36–180) Setting: Hospitals	Survey was tested with nursing managers and other staff from 79 hospitals in Canada. Four of the five factors on which the items loaded showed strong internal consistency reliability (α = 0.80–0.91), with one factor just missing the usual threshold for establishing adequate reliability (α = 0.68) (Innis et al., 2017)
Number: CM-22 Title: Overall Health Literacy Environment Rating Description: Sum of 5 domain scores based on Health Literacy Environment Review: navigation, print communication, oral exchange, technology, and policies and protocols	Measure source: Rudd & Anderson (2006) Data source: Staff assessment using Health Literacy Environment Review (Rudd & Anderson, 2006) Computation: Sum of print communication rating, technology rating, oral exchange rating, navigation rating, and policies and protocols rating Setting: Hospitals and other inpatient facilities, ambulatory care	None identified

Note. CM = consensus measure; OHL = organizational health literacy; PFE = person and family engagement.

^aMeasures identified through interviews with health care organizations working to improve their OHL are identified as having a Measure Source of “health care organization.” Because we assured participants in the organization interviews that their responses would remain confidential, we do not identify health care organizations by name.

^bSetting refers to the health care settings for which a measure is believed to be relevant (e.g., hospitals).

^cAlthough the PFE Hospital Evaluation Metrics were designed to assess engagement, we have categorized 3 of the 5 measures as addressing the Organizational Structure, Policy, & Leadership domain. For each of these measures, improved engagement is pursued through implementation of organizational structures and policies (i.e., staffing to support patient engagement efforts, patient involvement in committees).