Health Literacy, Hospital Discharge, and Cardiovascular Outcomes

健康素养、出院和心血管结局

• 批准号: 8321491
• 负责人: SUNIL KRIPALANI
• 金额: $ 69.72万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-17 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8321491
• 关键词: Accident and Emergency department; Acute; Address; Adherence; Adult; Adverse event; Affect; American; Appointment; Area; Back; Behavioral; Cardiovascular system; Caring; Cessation of life; Characteristics; Clinical; Cognitive; Cohort Studies; Communication; Complex; Data Analyses; Data Collection; Development; Enrollment; Feeling; Future; Goals; Health; Health Care Costs; Healthcare; Home environment; Hospitalization; Hospitals; Incidence; Instruction; Interdisciplinary Study; Intervention; Interview; Knowledge; Lead; Measures; Mediator of activation protein; Medical Errors; Medical Records; Medication Management; Medicine; Mentors; Modeling; Myocardial Infarction; Outcome; Patient Care; Patient Discharge; Patients; Pharmaceutical Preparations; Population; Population Study; Populations at Risk; Process; Provider; Readiness; Recommendation; Regimen; Reporting; Research; Research Personnel; Risk Factors; Role; Self Care; Self Management; Services; Social Sciences; Social support; Staging; Survival Analysis; System; Telephone; Testing; Time; United States Social Security Administration; Unstable angina; Visit; Work; acute coronary syndrome; adverse outcome; behavior measurement; career; cohort; experience; follow-up; functional status; health care service utilization; health disparity; health literacy; health related quality of life; high risk; hospital readmission; improved; interest; literacy; mortality; novel; physical conditioning; prevent; prospective; psychologic; therapy design

Project Summary The period following hospital discharge is a vulnerable time for patients in which poorly coordinated care and medication mismanagement are common. Suboptimal care in the peri-discharge period contributes to preventable adverse events, hospital readmission, and higher mortality, particularly in high-risk conditions such as acute coronary syndromes (ACS). Low health literacy is a prevalent risk factor for poor processes and outcomes of care, but little research has been conducted on the role of health literacy in this high-risk setting. The goal of this research is to examine how health literacy and other patient characteristics affect the quality of hospital discharge and related outcomes after hospitalization. We will test a conceptual framework that includes patient-, provider-, and system-related factors as potential mediators and moderators of these relationships. The Specific Aims are to: 1) Determine the association of health literacy with the quality of hospital discharge, including the impact on communication, preparedness for discharge, and subsequent medication management. 2) Examine the effect of health literacy and hospital discharge quality on functional status, health- related quality of life, and unplanned health care utilization 30 and 90 days after hospital discharge. 3) Examine the effect of health literacy and hospital discharge quality on mortality after hospitalization. We will perform a prospective cohort study of 3,000 adults hospitalized for ACS and discharged to home. Data collection and analyses will be grounded in a conceptual framework that relates health literacy to processes and outcomes of care. During hospitalization, we will administer a robust set of validated sociodemographic, educational, cognitive, psychological, cultural, and behavioral measures. For Aim 1, we will interview patients by telephone 2-3 days after discharge to assess the quality of hospital discharge, including measures of patient-provider communication and preparedness for discharge. For Aim 2, we will review medical records and interview patients by telephone 30 and 90 days after discharge to assess changes in functional status, health-related quality of life, and unplanned health care utilization, including Emergency Department visits and rehospitalization. For Aim 3, we will ascertain mortality using the Social Security Administration Death Master File, following patients for up to 3.5 years after enrollment. We will use multivariable path analyses and survival analyses to model the direct and indirect relationships among health literacy, other measured factors, potential mediators or moderators, and each outcome of interest. This interdisciplinary research will greatly enhance our understanding of how health literacy affects hospital discharge processes and outcomes after hospitalization. Findings will enable us to better design interventions to improve services for patients with low health literacy, as well as other high-risk groups. Knowledge gained from this study may also help improve cardiovascular outcomes and reduce literacy-related health disparities.

项目概要 出院后的一段时间对于患者来说是一个脆弱的时期，护理协调不力 药物管理不善也很常见。出院期间的次优护理会导致 可预防的不良事件、再入院和更高的死亡率，特别是在高风险情况下，例如 如急性冠状动脉综合征（ACS）。健康素养低下是流程不良和 护理结果，但很少有人研究健康素养在这种高风险环境中的作用。 本研究的目的是探讨健康素养和其他患者特征如何影响 出院质量和住院后的相关结果。我们将测试一个概念框架 其中包括患者、提供者和系统相关因素作为这些因素的潜在中介和调节因素 关系。具体目标是： 1) 确定健康素养与出院质量的关联，包括影响 关于沟通、出院准备和随后的药物管理。 2) 检查健康素养和出院质量对功能状态、健康状况的影响 相关的生活质量以及出院后 30 天和 90 天的计划外医疗保健利用。 3）考察健康素养和出院质量对住院后死亡率的影响。 我们将对 3,000 名因 ACS 住院并出院回家的成年人进行前瞻性队列研究。 数据收集和分析将建立在一个概念框架的基础上，该框架将健康素养与 护理的过程和结果。在住院期间，我们将管理一套经过验证的强有力的 社会人口、教育、认知、心理、文化和行为测量。对于目标 1，我们将 出院后2-3天通过电话采访患者，评估出院质量，包括 患者与提供者沟通和出院准备的措施。对于目标 2，我们将回顾 出院后 30 天和 90 天通过电话采访患者病历并评估病情变化 功能状态、与健康相关的生活质量以及计划外的医疗保健利用，包括紧急情况 科室就诊和再住院。对于目标 3，我们将使用社会保障确定死亡率 管理死亡主文件，在入组后对患者进行长达 3.5 年的跟踪。我们将使用 多变量路径分析和生存分析来模拟健康之间的直接和间接关系 识字率、其他测量因素、潜在中介或调节因素以及每个感兴趣的结果。 这项跨学科研究将极大地增强我们对健康素养如何影响医院的理解 出院过程和住院后的结果。研究结果将使我们能够更好地设计干预措施 改善对健康素养较低的患者以及其他高危人群的服务。获得的知识 这项研究还可能有助于改善心血管结果并减少与识字率相关的健康差异。