Brief Assessment of Health Literacy and Association with Cardiovascular Outcomes

描述(由申请人提供)：健康素养研究的数据收集是劳动密集型的，因为最广泛使用的健康素养衡量标准是由训练有素的研究人员亲自管理的。这限制了我们对健康素养不足的后果进行大规模流行病学研究的能力。它还限制了我们根据健康素养水平评估卫生系统干预措施有效性的能力，因为这一关键变量没有记录在临床数据库中。这些重要形式的研究将通过提供一种简短的口头管理的健康素养衡量标准来促进。三个简短的问题(“你自己填写医疗表格的信心有多大？”，“你多久让人帮你读一次医院材料？”，“你多久会因为难以理解书面信息而在了解自己的医疗状况时遇到问题？”)在之前的5项研究中，有效地识别了健康素养不足的患者。然而，这些项目尚未在门诊护理环境之外或在临床人员实施时进行测试。还没有进行严格的心理测量分析，也没有检查它们与临床结果的关系。这项建议的具体目的是：1)确定在入院时将简短的健康素养问题纳入电子健康记录(EHR)作为研究工具的可行性，2)对简短的健康素养问题进行心理测量评估，以及3)检查简短的健康素养问题与重要临床结果(包括血压控制和心力衰竭再入院)的独立关联。对于目标1，我们将把这些项目纳入范德比尔特大学医院(VUH)的入院护理病历，培训护士的管理，通过审核EHR中项目的护理文件来检查对健康素养措施的理解，并观察规模管理的准确性。对于目标2，我们将定义一个大的住院患者回顾队列，并招募一个较小的前瞻性队列。我们将评估内部一致性信度和重测信度，使用结构方程模型进行验证性因素分析，并通过比较健康素养问题对患者人口统计学和另一种健康素养测量指标的回答来检验结构效度。对于目标3，我们将定义一个有高血压诊断的VUU患者的回顾队列，以及一个因急性失代偿性心力衰竭而入院的队列。我们将在高血压组的入院时和门诊随访时，以及在心力衰竭组的急诊科就诊和出院后60天内重新入院的情况下，研究简短的健康知识项目与血压的关系。通过单独和组合考察健康素养项目，并控制年龄、种族和教育程度，我们将确定哪个项目(S)最适合作为健康素养的简短测量。 公共卫生相关性：医学研究所关于健康素养的报告呼吁进行更多的研究，以更好地了解健康素养不足的后果，并采取基于系统的干预措施来解决健康素养问题，这些干预措施应按健康素养水平分析干预效果。然而，由于缺乏可纳入大型调查或电子健康记录作为研究工具的有效和简短的健康素养衡量标准，这些领域的进展受到限制。本研究试图验证3个可广泛用于此类研究的候选健康素养问题。

DESCRIPTION (provided by applicant): Data collection for health literacy research is labor intensive because the most widely used measures of health literacy are administered in-person by trained research staff. This limits our ability to perform large epidemiological studies on the consequences of inadequate health literacy. It also restricts our ability to assess the effectiveness of health system interventions by level of health literacy, because this critical variable is not being recorded in clinical databases. These important forms of research would be facilitated by the availability of a brief, verbally-administered measure of health literacy. Three short questions ("How confident are you filling out medical forms by yourself?," "How often do you have someone help you read hospital materials?," and "How often do you have problems learning about your medical condition because of difficulty understanding written information?") effectively identified patients with inadequate health literacy in 5 previous studies. However, these items have not yet been tested outside of the ambulatory care setting or when administered by clinical personnel. Rigorous psychometric analyses have not yet been performed, nor has their association with clinical outcomes been examined. The Specific Aims of this proposal are to: 1) Establish the feasibility of incorporating brief health literacy questions into an electronic health record (EHR) upon hospital admission for use as a research tool, 2) Perform a psychometric evaluation of the brief health literacy questions, and 3) Examine the independent association of the brief health literacy questions with important clinical outcomes including blood pressure control and heart failure readmissions. For Aim 1, we will incorporate the items into the admission nursing history at Vanderbilt University Hospital (VUH), train nurses in their administration, examine uptake of the health literacy measure by auditing nursing documentation of the items in the EHR, and observe encounters for fidelity of scale administration. For Aim 2, we will define a large retrospective cohort of hospitalized patients and enroll a smaller prospective cohort. We will assess internal consistency reliability and test-retest reliability, use structural equation modeling to perform confirmatory factor analysis, and examine construct validity by comparing responses on the health literacy questions to patient demographics and another health literacy measure. For Aim 3, we will define a retrospective cohort of patients who are admitted to VUH with a pre-existing diagnosis of hypertension, and a second cohort admitted for acute decompensated heart failure. We will examine the association of the brief health literacy items with blood pressure at the time of hospital admission and at outpatient follow-up in the hypertension cohort, and Emergency Department visits and hospital readmission within 60 days of discharge in the heart failure cohort. By examining the health literacy items alone and in combination, and controlling for age, race, and education, we will determine which item(s) are best suited as a brief measure of health literacy. PUBLIC HEALTH RELEVANCE: The Institute of Medicine report on health literacy called for additional research to better understand the consequences of inadequate health literacy, as well as system-based interventions to address health literacy, which should analyze intervention effectiveness by level of health literacy. However, progress in these areas is being limited by the absence of a valid and brief measure of health literacy that can be incorporated into large surveys or into the electronic health record for use as a research tool. This research seeks to validate 3 candidate health literacy questions which could be used widely for such research.