The period following hospital discharge is a vulnerable time for patients in which poorly coordinated careand medication mismanagement are common. Suboptimal care in the peri-discharge period contributes topreventable adverse events, hospital readmission, and higher mortality, particularly in high-risk conditions suchas acute coronary syndromes (ACS). Low health literacy is a prevalent risk factor for poor processes andoutcomes of care, but little research has been conducted on the role of health literacy in this high-risk setting. The goal of this research is to examine how health literacy and other patient characteristics affect thequality of hospital discharge and related outcomes after hospitalization. We will test a conceptual frameworkthat includes patient-, provider-, and system-related factors as potential mediators and moderators of theserelationships.
The Specific Aims are to: 1) Determine the association of health literacy with the quality of hospital discharge, including the impact on communication, preparedness for discharge, and subsequent medication management. 2) Examine the effect of health literacy and hospital discharge quality on functional status, health- related quality of life, and unplanned health care utilization 30 and 90 days after hospital discharge. 3) Examine the effect of health literacy and hospital discharge quality on mortality after hospitalization. We will perform a prospective cohort study of 3,000 adults hospitalized for ACS and discharged to home.Data collection and analyses will be grounded in a conceptual framework that relates health literacy toprocesses and outcomes of care. During hospitalization, we will administer a robust set of validatedsociodemographic, educational, cognitive, psychological, cultural, and behavioral measures.
For Aim 1, we willinterview patients by telephone 2-3 days after discharge to assess the quality of hospital discharge, includingmeasures of patient-provider communication and preparedness for discharge.
For Aim 2, we will reviewmedical records and interview patients by telephone 30 and 90 days after discharge to assess changes infunctional status, health-related quality of life, and unplanned health care utilization, including EmergencyDepartment visits and rehospitalization.
For Aim 3, we will ascertain mortality using the Social SecurityAdministration Death Master File, following patients for up to 3.5 years after enrollment. We will usemultivariable path analyses and survival analyses to model the direct and indirect relationships among healthliteracy, other measured factors, potential mediators or moderators, and each outcome of interest. This interdisciplinary research will greatly enhance our understanding of how health literacy affects hospitaldischarge processes and outcomes after hospitalization. Findings will enable us to better design interventionsto improve services for patients with low health literacy, as well as other high-risk groups. Knowledge gainedfrom this study may also help improve cardiovascular outcomes and reduce literacy-related health disparities.
National recommendations have called for research to better understand the consequences of limited health literacy, the mechanisms through which health literacy affects clinical outcomes, and the mediators and moderators of these relationships. Such work is particularly needed following patients'discharge from the hospital, when their physical condition and social supports may be most vulnerable. This research will lead to an improved understanding of how health literacy affects hospital discharge and post-discharge outcomes, thereby informing subsequent interventions to reduce health literacy-related disparities.
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| León-Pérez, Gabriela; Wallston, Kenneth A; Goggins, Kathryn M et al. (2016) Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization. J Behav Med 39:441-52 |
| McNaughton, Candace D; Cavanaugh, Kerri L; Kripalani, Sunil et al. (2015) Validation of a Short, 3-Item Version of the Subjective Numeracy Scale. Med Decis Making 35:932-6 |
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