JACKSONVILLE, FLA. (FRONTLINE MEDICAL NEWS) – Low health literacy is a common problem in Veterans Affairs health systems, and patients with low health literacy scores are 50% more likely to return to the hospital within 30 days of discharge after surgery than patients with high health literacy, investigators found in a study of surgery patients at VA medical centers.

“Low health literacy is prevalent among VA surgery patients and is associated with surgical readmissions,” said Samantha Baker, MD, of the University of Alabama at Birmingham and the VA Birmingham Healthcare System. She presented the findings at the Association for Academic Surgery/Society of University Surgeons Academic Surgical Congress.

The study evaluated health literacy and readmission rates among 722 patients who underwent general, vascular, or thoracic surgery operations at four VA sites from August 2015 to June 2017.

This study used an instrument developed by Lisa Chew, MD, at the University of Washington to determine health literacy scores ( Fam Med. 2004;36:588-94 ). The instrument uses three questions: how often patients have someone else help them read hospital materials; whether they have problems learning about a medical condition because they have difficulty understanding written information; and how confident they are in filling out their own medical forms. Answers are given on a scale of 0-4, with 12 points being the highest score for poor health literacy. This study considered adequate health literacy to be a score of 0-3, and 4-12 as “possibly inadequate health literacy.”

“Of the 722 patients who took the survey, 39.2% had a score of 0; 33.2% had a score of 4 or more,” Dr. Baker said.

The adequate health literacy group had significantly lower rates of unplanned readmissions and a trend toward lower emergency department visits than the possibly inadequate health literacy group, 11.7% vs. 22.5% (P = .003) for the former and 18.7% vs. 24.2% (P = .08) for the latter, Dr. Baker said.

She noted that the ethnic makeup of the groups was similar and the differences in health literacy among the ethnic groups were not statistically significant.

She also mentioned that those with adequate health literacy tended to be younger – 64 vs. 66.9 years – and more likely to be women (“but our number is low for females in the VA,” Dr. Baker said). She added that married patients tended to have lower heath literacy than did single patients.”

The 30-day surgical readmission rate was 13.7% for patients with high health literacy and 22.5% for those with low health literacy. Patients with inadequate health literacy were 53% more likely to be readmitted to the hospital within 30 days of their index operation, she said. Each one-unit increase in health literacy scores – meaning an increase in inadequate health literacy – increased an individual’s risk of readmission by about 6% on an adjusted basis, Dr. Baker said.

“Future work is going to be focused on identifying these patients and developing the interventions to educate and empower this vulnerable population before they are discharged,” Dr. Baker said.

Dr. Baker and coauthors reported having no financial disclosures.

SOURCE: Baker S et al. Academic Surgical Congress .


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