National Health Literacy Mapping to Inform Healthcare Policy

描述(由申请人提供)：我们的研究目标是为美国每个人口普查区组提供健康素养的有效估计，并证明这种健康素养衡量标准在为医疗研究、政策和实践提供信息方面的价值。健康素养，或 一个人获得过程和理解作出健康决定所需信息的能力，不仅被认为是个人技能和能力的反映，而且也被认为是卫生系统提供信息和服务情况的反映。因此，这一概念可以作为公共卫生和医疗保健的质量、公平和安全的指标。然而，与许多其他指标不同的是，健康素养被认为是可以修改的。利用健康知识“最佳做法”进行的干预措施已被证明能够改善健康结果。尽管健康素养很有希望，但它很少被纳入政策制定。健康素养是再次入院的最重要、最独立的危险因素之一。纳入健康素养原则的战略已成功地减少了再入院人数。这一点尤其重要，因为医疗补助和医疗保险服务中心(CMS)最近开始惩罚因急性心肌梗死(AMI)、心力衰竭(HF)和肺炎而调整后再住院率高于全国平均水平的医院。到目前为止，CMS使用的调整后的比率仅包括内科合并症和年龄。虽然处罚的目的是为了提高护理质量和降低成本，但缺乏对健康素养的调整给医院带来了不必要的负担，这些医院为那些面临健康素养低下风险最大、更有可能与自我作斗争的患者提供服务。 关爱活动。对健康素养进行调整将确保惩罚是公平的，并确定最需要健康素养知情倡议的医院。通过这项研究，我们将证明，使用兰德预测模型，可以为美国217,740个人口普查区组中的每一个群体估计一个衍生的健康素养衡量标准。通过将健康素养估计与约30万联邦医疗保险受益者的全国队列联系起来，我们将证明估计的预测性力量。然后，我们将把健康素养评估与全国约176,000名急性心肌梗死医疗保险患者队列联系起来，以检查健康素养对急性心肌梗死再次住院的影响。最后，我们将使用健康素养评估来增强调整后的急性心肌梗死再住院率的CMS分析模型(临床侧写收缩估计和风险调整)。我们的具体目标是：1a)估计并绘制美国每个人口普查区组的平均健康素养得分，1b)检查健康素养估计值与约300,000名联邦医疗保险受益人中临床终点结果(死亡率、心力衰竭、急性心肌梗死、中风、终末期肾脏疾病)的组合之间的关系，2)调查健康素养估计值对全国176,000名急性心肌梗死联邦医疗保险患者30天再入院的影响，以及3)比较在全国联邦医疗保险急性心肌梗死队列医院中，在对导出的健康素养得分进行调整和不调整的情况下的风险标准化再住院率。

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.