Patient-Reported Health Literacy Scores Associated With Readmissions Following Surgery

Transcription

1 Patient-Reported Health Literacy Scores Associated With Readmissions Following Surgery S. Baker1,2, L. Graham1,2, E. Dasinger1,2, T. Wahl1,2, J. Richman1,2, D. Chu1,2 L. Copeland3, E. Burns4, J. Whittle4, M. Hawn5, M. Morris1,2 1University Of Alabama at Birmingham, Birmingham, AL, USA 2VA Birmingham Healthcare System, Birmingham, AL, USA 3VA Central Western Massachusetts Health Care System, Leeds, MA, USA 4Milwaukee VA Medical Center, Milwaukee, WI, USA 5VA Palo Alto Healthcare Systems, Palo Alto, CA, USA

2 We have nothing to disclose

3 Background Surgical readmissions are a difficult problem Several studies using big data Health Literacy?

4 Hypothesis Patients with lower health literacy would be more likely to experience a 30 day readmission following surgery Health Literacy Readmission Rate

5 Methods Observational, Prospectively enrolled, Multi-instutional study 4 VA sites Birmingham Palo Alto Milwaukee Boston General, Vascular, Thoracic Surgery At least a 48 hour hospital stay, discharged alive Discharge Survey Measuring Health Literacy

6 Methods (1) In person interview (2) 30 day chart abstraction (3) 30 day follow up phone call 30 days Identify any VA or Outside Hospital Readmission

7 Defining Health Literacy Additive score for three 5-item Likert scale questions. (Range 0-12 points) How often do you have someone help you read hospital materials? How often do you have problems learning about a medical condition because of difficulty understanding written information? How confident are you filling out medical forms by yourself? Always +4 Always +4 Always +0 Often +3 Often +3 Often +1 Sometimes +2 Sometimes +2 Sometimes +2 Occasionally +1 Occasionally +1 Occasionally +3 Never +0 Never +0 Never +4 Chew, L., Bradley, K., & Boyko, E. (2004). Brief Questions to Identify Patients With Inadequate Health Literacy. Family Medicine, 36(8), Retrieved from

8 Defining Health Literacy Adequate Possibly Inadequate Carmona, R., & Pleasant, A. (october 2017). Becoming Literate in Health Literacy. JAMA Surgery. doi: /jamasurg Wright, J., Edwards, G., Goggins, et al. (october 2017). Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. JAMA Surgery, E1-E6. doi: /jamasurg

9 Study Population 736 inpatient surgeries enrolled at 4 study sites. 722 (98%) with complete health literacy information at discharge.

10 Demographics N / Median (%) / (IQR) Age, median (Q1, Q3) 67.0 ( ) Race, n (%) Black 92 (12.8) Other 21 (2.9) White 607 (84.3) Gender, n (%) Female 29 (4.0) Male 692 (96.0) ASA Classification, n (%) (8.5) (76.5) (15.0) Charlson Comorbidity Index, median (Q1, Q3) 4.0 ( ) PCS (Physical Component Score) 30.9 ( ) MCS (Mental Component Score) 50.7 ( )

11 Health Literacy at Discharge 722 Patients 39.2% had a score of % (N=240) of patients had possibly inadequate health literacy Score of 4 or more

12 Population Characteristics by HL N=722 Adequate Health Literacy 3 or Less Possibly Inadequate Health Literacy 4 or More P-Value N / Mean % / SD N / Mean % / SD Race 0.07 White % % Black % % Other / Unknown % % Age, years, Mean (SD) 64.1 (10.5) 66.9 (9.1) <.001 Gender 0.02 Female % 4 1.7% Male % % Marital Status <.001 Married % % Separated / Divorced % % Widowed % % Single / Never Married % % Charlson Comorbidity Index, Mean (SD) 3.7 (2.9) 4.5 (3.3) 0.002

13 Readmission & Emergency Department (ED) Visits Overall within 30 days of discharge: 117 Patients 151 Patients 16.7% readmitted 20.5% presented to the ED

14 Hospital visits by HL Unplanned Readmission p=0.003 ED visit p=0.08

15 Length of Stay (LOS) & Mortality Overall within 30 days of discharge:? Days? Patients Average LOS % Mortality Rate

16 LOS by HL Index Hospitalization LOS p=? Readmission LOS p=?

17 Adjusted Model of Readmission Unadjusted Most Parsimonious* OR (95% CI) p-value OR (95% CI) p-value Adequate Ref. Ref Possibly Inadequate 1.83 ( ) ( ) 0.04 Every 1 Unit Increase 1.09 ( ) ( ) 0.08 * Adjusted for Charlson Comorbidity Index, Health Survey Physical Component Score and Mental Component Score at the time of discharge Patients with possibly inadequate health literacy at the time of hospital discharge are 53% more likely to be readmitted as compared to patients with adequate health literacy.

18 Limitations Several tools to measure HL Lack validated/consistent cut-offs Adequate HL vs. Marginal HL vs. Inadequate HL VA population, may not be generalizable

19 Implications/ Future Work Low Health Literacy is prevalent among VA surgery patients Low Health Literacy is associated with surgical readmissions Identifying these patients and developing interventions to educate and empower

20 Dept. Surgery at UAB Dr. Morris Dr. Hawn Research Teams at Boston, Milwaukee, Palo Alto Laura Graham Elise Dasinger Lauren Goss Emily Malone Tyler Wahl Dr. Chu Dr. Richman VAQS Dr. Estrada Dr. Patrician

21 Patient-Reported Health Literacy (HL) Scores Associated With Readmissions Following Surgery Low HL Prevalent among Surgical Population Readmission Rates higher with low HL Linear Relationship between HL and Surgical Readmissions 33% score >4 (on HL screening tool) 22% vs. 13% (percent of readmitted patients, Low HL vs Adequate HL) p=0.003 Low HL 53% more likely to be readmitted p=0.04 S. Baker, L. Graham, E. Dasinger, T. Wahl, J. Richman, D. Chu, L. Copeland, E. Burns, J. Whittle, M. Hawn, M. Morris

22 Adjusted Model of Readmission 1.0 = No Difference For every 1 unit increase in Health Literacy Score, there is a 5.5% increase in odds of readmission.

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24 Population Characteristics by HL Adequate (3 or Less) Health Literacy Score Possibly Inadequate (4 or More) P-Value Mean (SD) Mean (SD) CTM15 Mean Score 3.3 (0.4) 3.2 (0.4) VR12 Physical Component Score 32.0 (11.9) 29.5 (12.2) 0.01 VR12 Mental Component Score 49.7 (11.5) 45.9 (13.9) <.001