Is Low Health Literacy Associated with Increased Emergency Department Utilization and Recidivism?
Published Date:Oct 2014
Source:Acad Emerg Med. 21(10):1109-1115.
Pubmed Central ID:PMC4626077
Funding:3U54CA153460-03S1/CA/NCI NIH HHS/United States
KL2 RR024994/RR/NCRR NIH HHS/United States
KM1 CA156708/CA/NCI NIH HHS/United States
KM1CA156708/CA/NCI NIH HHS/United States
P30 DK092950/DK/NIDDK NIH HHS/United States
P50 CA95815/CA/NCI NIH HHS/United States
R01 CA168608/CA/NCI NIH HHS/United States
R21 HS020309/HS/AHRQ HHS/United States
TL1 RR024995/RR/NCRR NIH HHS/United States
U58 DP0003435/DP/NCCDPHP CDC HHS/United States
UL1 RR024992/RR/NCRR NIH HHS/United States
To determine whether patients with low health literacy have higher ED utilization and higher ED recidivism than patients with adequate health literacy.
The study was conducted at an urban academic ED with over 95,000 annual visits that is part of a 13-hospital health system, using electronic records that are captured in a central data repository. As part of a larger, cross sectional, convenience sample study, health literacy testing was performed using the short test of functional health literacy in adults (STOFHLA), and standard test thresholds identifying those with inadequate, marginal, and adequate health literacy. The authors collected patients' demographic and clinical data, including items known to affect recidivism. This was a structured electronic record review directed at determining 1) the median number of total ED visits in this health system within a 2-year period, and 2) the proportion of patients with each level of health literacy who had return visits within 3, 7, and 14 days of index visits. Descriptive data for demographics and ED returns are reported, stratified by health literacy level. The Mantel-Haenszel chi-square was used to test whether there is an association between health literacy and ED recidivism. A negative binomial multivariable model was performed to examine whether health literacy affects ED use, including variables significant at the 0.1 alpha level on bivariate analysis, and retaining those significant at an alpha of 0.05 in the final model.
Among 431 patients evaluated, 13.2% had inadequate, 10% had marginal, and 76.3% had adequate health literacy as identified by S-TOFHLA. Patients with inadequate health literacy had higher ED utilization compared to those with adequate health literacy (p = 0.03). Variables retained in the final model included S-TOFHLA score, number of medications, having a personal doctor, being a property owner, race, insurance, age, and simple comorbidity score. During the study period, 118 unique patients each made at least one return ED visit within a 14-day period. The proportion of patients with inadequate health literacy making at least one return visit was higher than that of patients with adequate health literacy at 14 days, but was not significantly higher within 3 or 7 days.
In this single-center study, higher utilization of the ED by patients with inadequate health literacy when compared to those with adequate health literacy was observed. Patients with inadequate health literacy made a higher number of return visits at 14 days but not at 3 or 7 days.
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