Teach-Back
Patient and Family Engagement in Primary Care
Slide 1: Teach-Back
AHRQ Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families.
Slide 2: Speaker
Kelly Smith, PhD
Scientific Director, Quality & Safety
Co-PI, AHRQ Guide to Improve Patient Safety in Primary Care Settings by Engaging Patients and Families
kelly.m.smith@medstar.net
No financial conflicts of interest to disclose.
Slide 3: Objectives
- Review the key threats to patient safety in primary care settings and interventions to engage patients and families to improve safety.
- Describe the role and value of teach-back in improving patient safety.
- Identify strategies for implementing the teach-back process in primary care settings.
Slide 4: Guide – Project Goals
- Meaningful engagement with patients and families in ways that impact safety, not just quality.
- Based on evidence.
- Tools that are easy to use.
- Tools for practices who have not done much in this area.
Slide 5: Key Project Deliverables
- Environmental Scan.
- Four Case Studies of Exemplar Practices.
- Four Interventions to Improve Safety by PFE.
- Final Guide.
Slide 6: Key Threats & Promising Interventions
Threats to Patient Safety
- Breakdowns in communication.
- Medication management.
- Diagnosis and treatment.
- Fragmentation and environment of care.
Promising Interventions
- Shared Decisionmaking.
- Patient and Family Advisory Councils (PFAC).
- Team-based Care.
- Medication Management.
- Family engagement in care.
- Structured communication tools.
Slide 7: Patient & Family Engagement in Primary Care
Image: Circle diagram with triangle in center demonstrating how strategies to engage patients and families can link the patient, clinicians, and practice staff together in a resilient relationship. The figure also shows that external factors such as the health care system, culture, community, and environment also play a role.
Slide 8: Four Interventions
- Teach-Back.
- Be Prepared to be Engaged.
- Medication Management.
- Warm Handoff.
Slide 9: What is Teach-Back?
- Evidence-based Health Literacy Intervention.
- Communication approach for shared decision-making.
- Ask your patients to “Teach it Back”.
Slide 10: Why Use Teach-Back?
Images: Doughnut chart showing how much medical information patients forget.
A job aid to remind clinicians of tips for successful teach-back.
Slide 11: When Is Teach-Back Used?
Teach-back can be used when you explain:
- A new diagnosis.
- Medication need and proper use.
- Home care instructions.
- Recommended behavior changes.
- Treatment options.
- Treatment plan.
- Use of a new device.
- Next steps.
Slide 12: Teach-Back Process
Image: Circle diagram of the teach-back process. The steps in the process are: Share, Ask, Listen, Share Again, Ask Again.
Patient and Family Engagement in Primary Care. Content last reviewed November 2016. Agency for Healthcare Research and Quality, Rockville, MD.
Slide 13: How is Teach-back Different?
Image: A physician talking to a patient while they review infomation displayed on the screen of an electronic tablet.
“Just to be safe, I want to make sure we are on the same page. Can you tell me…”
“Can you show me how you would use this inhaler at home?”
"I want to make sure that I explained things clearly. Can you explain to me..."
Slide 14: Making Teach-Back Successful
- Use teach-back on all patients.
- Start with the most important message.
- Focus on 2 to 4 key points.
- Use plain language. No medical jargon.
Slide 15: Teach Back Materials
Image: Materials, including flyers, posters, and pocket cards, used in the Teach-back strategy.
Link to Teach-back materials on AHRQ project website
Slide 16: Getting Started with Teach-back
- Step 1 - Identify a Champion and get Leadership Buy-in.
- Step 2 - Train all team members.
- Step 3 - Begin Implementation.
- Step 4 - Introduce teach-back to patients.
- Step 5 - Evaluate and refine.
Slide 17: Support for Training
- Interactive module.
- Case-based learning.
- Takes about 15 minutes to complete.
- Supportive materials and resources on AHRQ website.
Slide 18: Introduce Teach-back to Patients
- Reinforce the message “this is not a test” but a “safety check”.
- Use patient materials and underline or circle important points.
- Use pictures or draw diagrams.
- Ask open ended questions & use plain language.
Image: Flyer or poster to inform patients about the Teach-back strategy.
Slide 19: Using Plain Language
Image: Graphic which shows the "use this" in green and "not that" in red to indicate plain language that should be used instead of meidcal jargon.
Use This | Not That |
---|---|
✔ High blood pressure | X Hypertension |
✔ Not cancer | X Benign |
✔ Heart doctor | X Cardiologist |
✔ Skin doctor | X Dermatologist |
Slide 20: Guide Resources to Support Plain Language
Images: Back of job aid to give clinicians examples of using plain language instead of medical jargon.
Front of job aid to remind clinicians of tips for successful teach-back.
Slide 21: Evaluate Progress
Images: Survey to be used by clinicians and staff to assess the use of teach-back throughtout the practice.
Survey for clinicians to self-assess their use of teach-back.
Slide 22: Considerations with Older Adults
- Mild or moderate hearing impairments
- Use a lower voice pitch.
- Speak naturally and distinctly.
- Minimize background noise.
- Decline in information processing speed
- Slow down the rate of delivery.
- Limit new information given at each visit.
Slide 23: Considerations with Children
- Include the child in developmentally appropriate conversations.
- Ensure both the child and the caregiver understand.
- Use visual aids to support communication.
Slide 24: Considerations with Language Diversity
- Offer medical translation services.
- Use both verbal and nonverbal cues.
- Use visual aids to support.
Slide 25: How can the AHRQ PFE Guide help practices achieve success?
Image: Logic model showing PTN PFE performance dashboard domains and practice assessment tool PFE metrics. Strategy categories such as Etool, shared decision making, health literacy, patient activation, medication management, and support for patient voices can affect four PFE domains: internal PFE structure, spread to practices, PFE success stories, and innovation. There are two PFE metrics: practice can demonstrate that it encourages patients and families to collaborate and practice has a formal approach to obtaining patient and family feedback.
Slide 26: Why Should I Use Teach-Back?
- Improved patient outcomes.
- Safer care and adherence.
- Fewer calls to re-explain care plan due to misunderstandings.
- Improved patient and clinician satisfaction.
- Increased incentive payments
- Public and private performance measures.
- Patient satisfaction scores.
Slide 27: Questions?
Questions?
Slide 28: References
- Scholle S, Torda P, Peikes D, et al. Engaging Patients and Families in the Medical Home. 2010. https://pcmh.ahrq.gov/sites/default/files/attachments/Engaging%20Patients%20and%20Families%20in%20the%20Medical%20Home.pdf. Accessed November 8, 2016.
- Herrin J, Harris KG, Kenward K, et al. Patient and family engagement: a survey of US hospital practices. BMJ Qual Saf. June 2015.
- Smith KM, Hatlie MJ, Mayer DB, McDonald TB. A 10-year journey engaging patients in patient safety education, research and improvement. In: International Society for Communication Science and Medicine. Montecatini Terme, Italy; 2015:SP57, p36.
- Lewis BM. PFACs: Where’s the money? the financial impact on hospitals. The Beryl Institute. http://www.ipfcc.org/advance/topics/beryl-inst-patient-exp-research-rpt.pdf. Accessed November 8, 2016.
- Hancock K, Clayton JM, Parker SM, et al. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manag 2007 Aug 31;34(2):190-200.http://dx.doi.org/10.1016/j.jpainsymman.2006.11.009. Accessed September 15, 2016.
- Keulers BJ, Scheltinga MR, Houterman S, et al. Surgeons underestimate their patients’ desire for preoperative information. World J Surg 2008 Jun 1;32(6):964-70.
- Anderson JL, Dodman S, Kopelman M, et al. Patient information recall in a rheumatology clinic. Rheumat 1979;18(1):18-22. http://dx.doi.org/10.1093/rheumatology/18.1.18. Accessed September 15, 2016.
- Kessels RP. Patients' memory for medical information. J Roy Soc Med 2003 May 1;96(5):219-22.
- Dinh H, Bonner A, Clark R, et al. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database System Rev Implement Rep 2016;14(1):210-47. http://dx.doi.org/10.11124/jbisrir-2016-2296. Accessed September 15, 2016.