Patient Safety, 2009

Marshfield Clinic
Family Health Center of Marshfield, Inc.

September 2009

Marshfield Clinic in Wisconsin, one of the largest medical group practices in the United States, and Family Health Center of Marshfield, Inc., a community health center affiliated with Marshfield Clinic, are using some of AHRQ's patient education tools, tailoring them to the needs of particular segments of their patient population.

Questions Are the Answer, a public education campaign featuring an interactive AHRQ Web site (http://www.ahrq.gov/questionsaretheanswer/) that encourages patients to ask questions during their medical visits, is proving especially useful, according to Doug Seubert, Health Communications Specialist at Marshfield Clinic and Family Health Center of Marshfield, Inc.

Seubert and his colleagues have chosen to use the Questions Are the Answer site in their program in large part because they see the video and related materials as "patient activators." Questions Are the Answer conveys a series of positive messages, including:

• Patients should be active players on their health care team.
• They should come prepared for their medical visits.
• They should not be afraid to ask questions about their illnesses or their care.

"This patient-centered approach contrasts with an older, provider-centered notion of health education," Seubert observes. Seubert also appreciates the rich supply of information offered on the Questions Are the Answer Web site. Because patients can easily become overloaded with unusable information, he picks out "bite-size chunks" to make available to patients, based on their needs.

Patients visiting Marshfield Clinic's public Web site can find a collection of AHRQ-developed publications, Be Prepared for Medical Appointments, (https://www.marshfieldclinic.org/patients/?page=about_prepareForMedAppointments), derived from the Questions Are the Answer site. The Marshfield Clinic Web site also links directly to an interactive Question Builder tool on the AHRQ Questions Are the Answer Web site.

The Patients and Visitors section of Marshfield's Web site includes a Health and Wellness library, with access to information on more than 4,000 topics relating to health and medication. Questions Are the Answer has a prominent place in this library, as do other AHRQ tools, including Quick Tips: When Getting Medical Tests and Quick Tips: When Getting a Prescription.

However, about 70 percent of Family Health Center patients have no access to the Internet. To reach this population, Seubert has modified his communications strategies, adapting materials from the Questions Are the Answer Web site. For example, three printed newsletters are sent to all Family Health Center households on a rotating quarterly schedule. Tips for Talking with Your Doctor and Questions Are the Answer have been included in these newsletters.

Marshfield Clinic is also addressing the problem of limited health literacy in its service area. Clinic staff have collaborated with faculty at Mid-State Technical College, a local community college with campuses in Marshfield and Wisconsin Rapids, and with the Literacy Council of Wood County to develop a health literacy curriculum for Adult Secondary Credit classes, GED preparation, and English as a Second Language tutoring. Various components of Questions Are the Answer are featured in a unit titled How to Talk to Health Professionals. Depending on the setting, the teacher or tutor can show the TV public service announcement included in the Questions Are the Answer Web site, demonstrate the interactive Question Builder tool, or use role-playing exercises to give students a chance to practice conversations with medical professionals.

"We know that these interventions get patients to ask more questions. It is no big leap to suggest that increased patient satisfaction, higher levels of trust, and increased patient involvement lead to better understanding, improved patient adherence, and a decrease in opportunities for miscommunication and medical errors," Seubert says. "Overall, these benefits have a positive impact on health."

Marshfield Clinic provides health care, health education, and medical research at its headquarters in Marshfield, Wisconsin, and throughout its system of more than 40 locations in central, western, and northern Wisconsin. Patients come from every county in Wisconsin, every state in the nation, and more than 25 foreign countries.

The Family Health Center of Marshfield, Inc., is a federally funded community health center. Its mission is to improve access to primary care services for the medically underserved and to enhance the health of its communities. Family Health Center provides primary and specialty care through a contractual arrangement with Marshfield Clinic to low-income, underinsured, and uninsured individuals in north central Wisconsin. The center also has an affiliated network of physicians, hospitals, and dentists to provide comprehensive care throughout an 8,287-square-mile, predominantly rural service area.

Impact Case Study Identifier: Multi-Center 09-01
AHRQ Product: Questions Are the Answer
Topic(s): Health Literacy, Academic Curriculum
Scope: Wisconsin

Katz MG, Jacobson TA, Veledar E, Kripalani W. Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis. Journal of General Internal Medicine, June 2007; 22 (6): 782-6.

Davis RE, Koutantji M, Vincent CA. How willing are patients to question healthcare staff on issues related to the quality and safety of their healthcare? An exploratory study. Quality and Safety in Health Care, April 2008; 17 (2): 90-6.

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Current as of January 2010

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Internet Citation:

Impact Case Studies and Knowledge Transfer Case Studies: Patient Safety, 2009. January 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/casestudies/ptsafety/ps2009.htm

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