Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients
Sunil Kripalani, MD, MSc, SFHM, Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1200, Nashville, TN 37203; Telephone: 615-936-7231; Fax: 615-875-2655; E-mail: email@example.com
BACKGROUND: In discharge planning, a patient needs assessment helps to identify risk factors that should be addressed to promote a safe and effective transition in care. Low health literacy is associated with worse postdischarge outcomes, but little research has examined its relation to other addressable risk factors.
OBJECTIVE: To examine the association of health literacy with the number and type of transitional care needs (TCN) among patients being discharged to home.
DESIGN, SETTING, PARTICIPANTS: A cross-sectional analysis of patients admitted to an academic medical center.
MEASUREMENTS: Nurses administered the Brief Health Literacy Screen and documented TCNs along 10 domains: caregiver support, transportation, healthcare utilization, high-risk medical comorbidities, medication management, medical devices, functional status, mental health comorbidities, communication, and financial resources.
RESULTS: Among the 384 patients analyzed, 113 (29%) had inadequate health literacy. Patients with inadequate health literacy had needs in more TCN domains (mean = 5.29 vs 4.36; P < 0 .001). In unadjusted analysis, patients with inadequate health literacy were significantly more likely to have TCNs in 7 out of the 10 domains. In multivariate analyses, inadequate health literacy remained significantly associated with inadequate caregiver support (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.37-4.99) and transportation barriers (OR, 1.69; 95% CI, 1.04-2.76).
CONCLUSIONS: Among hospitalized patients, inadequate health literacy is prevalent and independently associated with other needs that place patients at a higher risk of adverse outcomes, such as hospital readmission. Screening for inadequate health literacy and associated needs may enable hospitals to address these barriers and improve postdischarge outcomes.
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