Association between Health Literacy and 30-Day Unplanned Healthcare Use after Discharge in the Heart Failure Population



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Unplanned healthcare use following discharge costs Medicare over $17 billion per year. Health literacy is associated with increased healthcare use and cost while heart failure is the leading cause of 30-day readmission in the United States. Previous studies have assessed the association between health literacy and hospitalization or mortality in the heart failure population utilizing different assessment tools including S-TOFHLA, REALM, and 3-Question Brief Health Literacy Assessment (BHLS). However, no study to date has used the 3-Question BHLS to assess the association of health literacy and 30-day unplanned healthcare use in this population. The aim of this study was to assess 30-day unplanned readmissions and emergency department visits based on health literacy evaluated by the BHLS in acute care heart failure patients.

This was a prospective, observational cohort study conducted at a large quaternary health-system. Patients admitted to the institution with a diagnosis of heart failure were included in the study. Patients that consented to enrollment were asked to independently complete the BHLS. Scores were then assigned and patients categorized as either the low or adequate health literacy. Thirty-one days after discharged, the electronic medical record at the study institution was reviewed or the patient was called to identify unplanned ED visits or readmissions to other institutions.

Primary analysis was to determine whether health literacy status measured using the BHLS was associated with unplanned healthcare use after discharge including 30-day ED visits and readmissions. The chi-square test was conducted for nominal data and student’s t-test for continuous data. A stepwise multivariate regression model was built to adjust for confounding variables.

300 patients were enrolled into the study and 264 patients were included in the final analysis. Of these, 175 (66.3%) had adequate health literacy and 89 (33.7%) had low health literacy. A total of 104 patients had unplanned healthcare use of either an ED visit or readmission within 30 days of discharge. Of these, 43 (41.3%) had low health literacy compared with 61 (58.7%) that had adequate health literacy (p=0.034). After multivariate logistic regression, low health literacy was identified as an independent predictor of 30-day unplanned healthcare use in the heart failure population.

The BHLS is a validated health literacy assessment tool that can be quickly administered, requires minimal instructions, and could be incorporated into current clinical health-system workflow. According to the study results, the BHLS is a predictor of 30-day unplanned healthcare use following discharge and could be used to guide discharge planning and counseling. Future studies should explore interventions to mitigate risk of unplanned healthcare use within 30-days of discharge in patients evaluated to have low health literacy using BHLS assessment.



Health literacy, Heart failure, BHLS, Readmissions, ED Visit, Unplanned Healthcare Use