title: Time, costs, and clinical utilization of screening for health literacy: a case study using the Newest Vital Sign (NVS) instrument.
abstract: OBJECTIVE
  Difficulties in identifying and caring for patients with limited health literacy have prompted interest in clinical screening to assess health literacy. Little agreement exists, however, on the utility of such screening. In this case study we explore the business and clinical cases for screening for health literacy using the Newest Vital Sign (NVS), a brief instrument specifically developed for use in primary care settings.
  
  
  METHODS
  Data were collected in 2008 in the Morehouse School of Medicine Department of Family Medicine Primary Care Clinic, where health literacy screening was implemented as part of routine intake procedures within an ongoing quality improvement effort to improve cardiovascular disease and diabetes outcomes. Specifically, we monitored time requirements, administrative and training costs, and clinician utilization associated with the NVS.
  
  
  RESULTS
  Results identified only small time and cost constraints associated with implementing NVS screening. Clinical utility was more problematic, however, because refresher trainings were needed to ensure continued staff and clinician buy-in, use of the NVS data, and implementation of best practices to communicate with at-risk patients.
  
  
  CONCLUSIONS
  Though the time and cost constraints associated with screening for health literacy were small, clinician utilization of this data in decision making and care processes may require further training and/or support.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Verna L
authors.initials: VL
authors.lastname: Welch
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: VanGeest
authors.forename: Rachel
authors.initials: R
authors.lastname: Caskey
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005845:Georgia; D017048:Health Care Costs / Q000706:statistics & numerical data*; D057220:Health Literacy / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D058996:Quality Improvement; D057566:Self Report; D013995:Time; D055986:Vital Signs