National Health Literacy Mapping to Inform Healthcare Policy

全国健康素养地图为医疗保健政策提供信息

基本信息

批准号：
8760512
负责人：
Stacy C Bailey
金额：
$ 51.95万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8760512
关键词：
Accounting Acute myocardial infarction Age Attenuated Behavior Censuses Clinical Code Comorbidity Diabetes Mellitus Digit structure Disease Elderly End stage renal failure Enrollment Ensure Health Health Policy Health Services Research Health system Healthcare Heart failure Hospitals Hypertension Individual Information Services Intervention Knowledge Lead Link Low income Maps Measures Medical Medicare Methods Minority Groups Modeling Outcome Patients Pneumonia Policies Population Process Public Health Quality Indicator Quality of Care Research Resources Risk Risk Adjustment Risk Factors Safety Self Care Services Stroke Structure United States United States Centers for Medicare and Medicaid Services beneficiary cohort cost evidence base health literacy high risk hospital readmission improved literacy modifiable risk mortality patient population predictive modeling public health relevance safety net skills socioeconomics therapy design tool

项目摘要

DESCRIPTION (provided by applicant): Our study objective is to provide valid estimates of health literacy for every census block group in the U.S. and demonstrate the value of such a health literacy measure for informing healthcare research, policy and practice. Health literacy, or one's ability to obtain process and understand information needed to make health decisions, is considered not only a reflection of an individual's skills and abilities, but also how well health systems provide information and services. This concept therefore serves as an indicator of the quality, equity, and safety of public health and healthcare. Unlike many other indicators, however, health literacy is considered modifiable. Interventions utilizing health literacy 'best practices' have been shown to lead to improved health outcomes. Despite its promise, health literacy has rarely been included in policymaking. Health literacy is one of the most important, independent risk factors for hospital readmission. Strategies that incorporate health literacy principles have successfully reduced readmissions. This is particularly significant as the Centers for Medicaid & Medicare Services (CMS) recently began penalizing hospitals with adjusted readmission rates above the national average for acute myocardial infarction (AMI), heart failure (HF) and pneumonia. To date, the adjusted rates used by CMS include only medical comorbidity and age. While the purpose of the penalties is to promote quality of care and reduce costs, the lack of adjustment for health literacy places an undue burden on hospitals that serve patients who are at greatest risk for low health literacy and are more likely to struggle with self care activities. Adjusting for health literacy would ensure that penalties are fair and identify hospitals in greatest need of health literacy-informed initiatives. Through this study, we will demonstrate that a derived health literacy measure can be estimated for each of the 217,740 census block groups in the U.S. using the RAND predictive model. By linking health literacy estimates to a national cohort of ~300,000 Medicare beneficiaries, we will demonstrate the predictive strength of the estimate. We will then link the health literacy estimates to a national cohort of ~176,000 Medicare patients with AMI to examine the impact of health literacy on hospital readmissions for AMI. Finally, we will we will use the health literacy estimates to augment the CMS analytical models (clinical profiling shrinkage estimation and risk-adjustment) of adjusted AMI readmission rates. Our specific aims are to: 1a) Estimate and map the average health literacy score of each census block group in the United States, 1b) Examine the relationship between health literacy estimates and a composite of clinical endpoint outcomes (mortality, HF, AMI, stroke, end-stage renal disease) among ~300,000 Medicare beneficiaries, 2) Investigate the impact of health literacy estimates on 30-day readmission among a national cohort of ~176,000 Medicare patients with AMI and 3) Compare the risk standardized readmission rates with and without adjustment for the derived health literacy score among the national Medicare AMI cohort for hospitals across the United States.

描述（由申请人提供）：我们的研究目标是为美国的每个人口普查组提供有效的健康素养估计，并证明这种健康素养措施在为医疗保健研究，政策和实践提供信息的价值中。健康素养或一个人获得制定健康决策所需的流程和理解信息的能力，不仅被认为是个人技能和能力的反映，而且还反映了卫生系统提供信息和服务的程度。因此，这个概念是公共卫生和医疗保健的质量，公平和安全的指标。但是，与许多其他指标不同，健康素养被认为可以修改。利用健康素养的“最佳实践”的干预措施已显示出改善的健康成果。尽管有希望，但健康素养很少被包括在决策中。健康素养是医院再入院的最重要，独立的风险因素之一。纳入健康素养原则的策略已成功减少了再入院。这一点尤其重要，因为最近的医疗补助和医疗保险服务中心（CMS）最近开始对医院进行调整后的急性心肌梗死平均水平（AMI），心力衰竭（HF）和肺炎的调整率。迄今为止，CMS使用的调整率仅包括医疗合并症和年龄。虽然处罚的目的是促进护理质量和降低成本，但缺乏对健康素养的调整使医院负担不当，这些医院为患有最大风险健康素养风险的患者提供了不适当的负担，并且更有可能与自我挣扎护理活动。调整健康素养将确保处罚是公平的，并确定最需要健康素养的计划的医院。通过这项研究，我们将证明，使用RAND预测模型，可以估计美国21740个人口普查块组中的每一个。通过将健康素养的估计与约300,000名Medicare受益人的全国人群联系起来，我们将证明该估计的预测力量。然后，我们将将健康素养估计的估计与大约176,000名Medicare AMI患者组成的全国人群联系起来，以检查健康素养对AMI医院再入院的影响。最后，我们将利用健康素养估计来增强调整后AMI再入院率的CMS分析模型（临床分析收缩估计和风险调整）。我们的具体目的是：1A）估计和绘制美国每个人口普查块组的平均健康素养评分，1b）检查健康素养估计与临床终点结果的复合估计与〜300,000 Medicare受益者的影响30,000的识别率的临床终点结果之间的关系（HF，AMI，Streoke，Streoke，treoke，ent阶段肾脏疾病）之间的关系。 AMI和3）患者比较了风险标准化率，并在美国国家医院的医疗保健AMI队列中对派生的健康素养评分进行调整，并进行比较。