Background: Health literacy (HL) is the measure of a person’s ability to obtain, process and understand basic health information and services to make appropriate health decisions.1 Previous studies note positive correlation between high HL and patient understanding of their condition.2 Patients with low HL have greater needs in transitional care domains, citing inadequate caregiver support and transportation barriers.3 One study detailed that unadjusted 30-day post-discharge hospital reutilization incidence rate ratio for low HL was 1.76.4 Moreover, low health literacy has been associated with worse post-discharge outcomes in specific conditions such as acute myocardial infarction, but little research has examined its relation to other conditions.5 Both studies utilized the Brief Health Literacy Screen (BHLS), a 3-question subjective HL assessment. To the authors knowledge, this is the first study that utilizes the Test of Functional Health Literacy in Adults (TOFHLA) to evaluate the role of HL in readmissions.6 The TOFHLA is an extensive evaluation tool to measure health information comprehension, unlike other instruments such as the BHLS.7
Methods: This study occurred at the Ronald Reagan UCLA Medical Center and UCLA Medical Center, Santa Monica. Trained quality improvement personnel interviewed patients at the bedside on Medicine-Surgery units utilizing the TOFHLA tool. The TOFHLA consists of 17 numeracy items and 3 prose passages and takes 22 minutes to administer. Upon administration, a raw score was recorded, which was later translated to one of the TOFHLA’s 3 levels of HL proficiency: inadequate (score range: 0-16), marginal (score range: 17-22), and adequate (score range: 23-36). Data was entered into a secure database and analyzed using t-test and chi-squared analysis. Demographic and 30-day readmissions data was recorded from chart review. Patients readmitted for organ transplant, maintenance chemotherapy, planned procedures or obstetrical delivery were considered planned readmissions and excluded.
Results: At the time of study analysis, 317 patients completed the TOFHLA. 22% of patients were found to have marginal or inadequate HL. The average TOFHLA score for the inadequate, marginal, and adequate HL respondents were 10.53, 19.83, and 31.69, respectively. There was a significant difference amongst patient age, and education level; the TOFHLA score decreased with age (P=0.0011), and increased with higher education level (P=0.0137).
Conclusions: Our analysis has yielded two salient findings: HL decreases with age and increases with level of education. Discharge outcome data are currently pending while the study becomes powered for this analysis and enough patients reach their 30-day readmission mark. Avenues for future intervention include universally screening the patient population with the more robust TOFHLA tool to identify patients that may have low health literacy, to ensure adequate care delivery and outcomes.