Published online October 27, 2009
PEDIATRICS Vol. 124 Supplement November 2009, pp. S315-S326 (doi:10.1542/peds.2009-1163H)

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SUPPLEMENT ARTICLE

Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety

Russell L. Rothman, MD, MPP^a, H. Shonna Yin, MD, MS^b, Shelagh Mulvaney, PhD^c, John Patrick T. Co, MD, MPH^d, Charles Homer, MD, MPH^e, Carole Lannon, MD, MPH^f

^a Departments of Medicine and Pediatrics
^c School of Nursing and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
^b Department of Pediatrics, New York University Medical Center, New York, New York
^d Department of Pediatrics, Mass General Hospital for Children, Boston, Massachusetts
^e National Initiative for Children's Healthcare Quality, Cambridge, Massachusetts
^f Center for Health Care Quality, Cincinnati Children's Hospital, Cincinnati, Ohio

Despite a heightened focus on improving quality, recent studies have suggested that children only receive half of the indicated preventive, acute, or chronic care. Two major areas in need of improvement are chronic illness care and prevention of medical errors. Recently, health literacy has been identified as an important and potentially ameliorable factor for improving quality of care. Studies of adults have documented that lower health literacy is independently associated with poorer understanding of prescriptions and other medical information and worse chronic disease knowledge, self-management behaviors, and clinical outcomes. There is also growing evidence to suggest that health literacy is important in pediatric safety and chronic illness care. Adult studies have suggested that addressing literacy can lead to improved patient knowledge, behaviors, and outcomes. Early studies in the field of pediatrics have shown similar promise. There are significant opportunities to evaluate and demonstrate the importance of health literacy in improving pediatric quality of care. Efforts to address health literacy should be made to apply the 6 Institute of Medicine aims for quality-care that is safe, effective, patient centered, timely, efficient, and equitable. Efforts should also be made to consider the distinct nature of pediatric care and address the "4 D's" unique to child health: the developmental change of children over time; dependency on parents or adults; differential epidemiology of child health; and the different demographic patterns of children and their families.

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Key Words: literacy • chronic illness • quality • safety

Abbreviations: IOM—Institute of Medicine • OTC—over-the-counter • FDA—Food and Drug Administration

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Accepted Jul 20, 2009.

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