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Abstract
Low health literacy is associated with higher mortality, higher rates of hospitalization, and poor self-management skills for chronic disease. Early, unplanned hospital reutilization after discharge is a common and costly occurrence in U.S. hospitals. Still, few studies have examined the relation between health literacy and 30-day hospital reutilization rates. The authors examined the association between health literacy and 30-day reutilization of hospital services (readmission or return to the emergency department) in an urban safety net hospital, and conducted a secondary analysis of data from the control arm subjects of the Project RED and the RED-LIT trials. Health literacy was measured using the REALM tool. The primary outcome was rate of 30-day reutilization. The authors used multivariate Poisson regression analysis to control for potential confounding. Of the 703 subjects, 20% had low health literacy, 29% had marginal health literacy, and 51% had adequate health literacy. Sixty-two percent of subjects had a 12th-grade education or less. Subjects with low health literacy were more likely to be insured by Medicaid (p < .001); Black non-Hispanic (p < .001); unemployed, disabled, or retired (p < .001); low income (p < .001); and less educated (high school education or less, p < .001). The fully adjusted incidence rate ratio for low health literacy compared with adequate health literacy was 1.46 (CI [1.04, 2.05]). Low health literacy is a significant, independent, and modifiable risk factor for 30-day hospital reutilization after discharge. Interventions designed to reduce early, unplanned, hospital utilization after discharge should include activities to mitigate the effect of patients’ low health literacy.
Acknowledgments
This work was supported by the Agency for Health Research and Policy 1K08HS019771-01 (Dr. Mitchell). The authors acknowledge Ms. Jessica Martin for her support in data preparation.
Notes
Note. Some columns may not add up to 100% because of omission of the “Other” categories. REALM: Rapid Estimate of Adult Literacy in Medicine.
*REALM scores are typically categorized into four categories; however, because of the distribution of the scores, the lowest two categories were combined into one category, resulting in three REALM categories.
**Free Care was a program in Massachusetts that aimed to fund medical care for uninsured individuals.
***Positive depression symptom screen determined by the Patient Health Questionnaire-9 screen tool, a nine-item 4-point Likert scale, standard scoring algorithm to screen for major and minor depression. A score of 5 or higher indicates a positive depression symptom screen.
Note. Some columns may not add up to 100% because of omission of the “Other” categories. REALM: Rapid Estimate of Adult Literacy in Medicine.
**Free Care was a program in Massachusetts that aimed to fund medical care for uninsured individuals.
**Positive depressive symptom screen determined by the Patient Health Questionnaire-9 screen tool, a nine-item 4-point Likert scale, standard scoring algorithm to screen for major and minor depression. A score of 5 or higher indicates a positive depression symptom screen.
