Health Literacy, Hospital Discharge, and Cardiovascular Outcomes

健康素养、出院和心血管结局

• 批准号: 8469080
• 负责人: SUNIL KRIPALANI
• 金额: $ 65.85万
• 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/8469080
• 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.

项目摘要 住院后的期间是协调不善的患者的脆弱时间 药物管理不善是普遍的。在围周期间的次优护理有助于 可预防的不良事件，住院再入院和更高的死亡率，尤其是在高风险条件下 作为急性冠状动脉综合征（ACS）。低健康素养是流程不良的普遍危险因素， 护理的结果，但是关于健康素养在这种高风险环境中的作用的研究很少。 这项研究的目的是研究健康素养和其他患者特征如何影响 住院后，住院质量和相关结果。我们将测试一个概念框架 其中包括患者 - 提供者和与系统相关的因素作为潜在的调解人和主持人 关系。具体目的是： 1）确定健康素养与住院质量的关联，包括影响 关于沟通，准备出院以及随后的药物管理。 2）检查健康素养和出院质量对功能状况的影响，健康 - 住院后30和90天，相关的生活质量和计划外的医疗保健利用。 3）检查健康素养和医院出院质量对住院后死亡率的影响。 我们将对3,000名住院的ACS并出院回家的前瞻性队列研究。 数据收集和分析将基于一个将健康素养与 过程和护理结果。在住院期间，我们将管理一组强大的经过验证 社会人口统计学，教育，认知，心理，文化和行为措施。对于目标1，我们将 出院后2-3天通过电话采访患者，以评估住院质量，包括 衡量患者提供者的沟通和出院准备。对于AIM 2，我们将审查 出院后30和90天通过电话进行病历和采访患者，以评估更改 功能状况，与健康相关的生活质量和计划外的医疗保健利用，包括紧急情况 部门访问和重新寄养。对于AIM 3，我们将使用社会保障确定死亡率 管理死亡主文件，在入学后长达3.5年后，病人。我们将使用 多变量路径分析和生存分析，以建模健康之间的直接和间接关系 识字，其他测量因素，潜在的介体或主持人以及感兴趣的每个结果。 这项跨学科研究将大大增强我们对健康素养如何影响医院的理解 住院后出院过程和结果。调查结果将使我们能够更好地设计干预措施 改善健康素养低的患者以及其他高风险群体的服务。知识获得了 从这项研究中，还可以帮助改善心血管结局并减少与识字相关的健康差异。