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. Previous studies note positive correlation between high HL and patient understanding of their condition. Patients with low HL have greater needs in transitional care domains, citing inadequate caregiver support and transportation barriers. 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.
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), Adequate (score range: 23-36). Demographic and 30-day readmissions data was recorded from chart review using EPIC EMR.
Results: 530 patients were enrolled in this study with an average TOFHLA of 29.92 (Std. dev: 13.17). Number of patients scoring Marginal or less health literacy was 110 (21% – consistent with phase 1 which had 23%). There was a negative correlation with health literacy score and 30-day readmissions. (r = -0.510). After linear regression analysis for TOFHLA vs. readmissions and inverse relationship consistent withcorrelation data was elucidated (R = -0.682, p <0.01). When comparing the LACE+ score vs. readmissions, a positive linear relationship was elucidated; however this relationship was not as strong as the TOFHLA for cases with <3 co-morbidities (R = 0.387, p <0.01).
Conclusions: Data from phase 1 of study details disparities amongst hospitalized Hispanic patients with regards to health literacy level, educational attainment and physician perception of health literacy. Health literacy increases patient rating in ability to engage with healthcare team. Based on current study data, TOFHLA may be predictive for future readmission given positive linear relationship. Additionally, TOFHLA may be more predictive for readmission compared to LACE+ score. Next steps include educational interventions to enhance health literacy amongst hospitalized patients, especially Hispanic patients. We will validate findings with sample population to compare predictive power of LACE+ vs. TOFHLA. We also will determine utility in incorporating health literacy screen into admission procedures or ancillary staff work-flow.