Health Literacy, Hospital Discharge, and Cardiovascular Outcomes

健康素养、出院和心血管结果

• 批准号: 8835140
• 负责人: SUNIL KRIPALANI
• 金额: $ 43.67万
• 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 2016-04-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8835140
• 关键词: 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; Emergency department visit; 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; 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 出院后的一段时间是患者护理协调不力的脆弱时期。 以及药物管理不善是很常见的。出院期间的次优护理有助于 可预防的不良事件、再次住院和更高的死亡率，特别是在高危条件下，如 作为急性冠脉综合征(ACS)。低健康素养是不良流程的普遍风险因素 护理的结果很重要，但关于健康素养在这一高风险环境中的作用的研究很少。 这项研究的目标是检验健康素养和其他患者特征如何影响 住院后出院质量及相关转归。我们将测试一个概念性框架 这包括与患者、提供者和系统相关的因素，作为这些因素的潜在中介和调节因素 两性关系。具体目标是： 1)确定健康素养与医院出院质量的联系，包括其影响 关于沟通、出院准备和随后的用药管理。 2)考察健康素养和出院质量对功能状态、健康状况的影响 相关生活质量以及出院后30天和90天非计划医疗保健利用情况。 3)探讨健康素养和出院质量对住院死亡率的影响。 我们将对3000名因急性冠脉综合征住院并出院回家的成年人进行前瞻性队列研究。 数据收集和分析将以一个概念框架为基础，该框架将卫生知识普及与 护理的过程和结果。在住院期间，我们将实施一套可靠的有效 社会人口学、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天通过电话访问病人，以评估出院质量，包括 患者-提供者沟通和出院准备的措施。对于目标2，我们将审查 出院后30天和90天通过电话记录和访问患者，以评估 功能状态、与健康相关的生活质量和计划外卫生保健利用，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来确定死亡率 管理死亡主档案，在登记后跟踪患者长达3.5年。我们将使用 多变量通径分析和生存分析，以模拟健康之间的直接和间接关系 扫盲、其他衡量因素、潜在的调解人或调解人，以及感兴趣的每个结果。 这项跨学科的研究将极大地增强我们对健康素养如何影响医院的理解 住院后的出院过程和结果。这些发现将使我们能够更好地设计干预措施 改善对健康素养低的患者以及其他高危群体的服务。获得的知识 这项研究还可能有助于改善心血管结果，减少与识字相关的健康差距。