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块组提供有效的健康素养估计，并证明这种健康素养措施对告知医疗保健研究，政策和实践的价值。健康知识，或 一个人获得、处理和理解作出卫生决策所需信息的能力不仅被认为反映了个人的技能和能力，而且也反映了卫生系统提供信息和服务的能力。因此，这一概念是公共卫生和医疗保健质量、公平和安全的指标。然而，与许多其他指标不同，卫生知识普及被认为是可以修改的。利用卫生知识普及“最佳做法”的干预措施已被证明可以改善健康成果。尽管卫生知识普及大有希望，但很少被纳入决策。 健康素养是再次入院的最重要的独立风险因素之一。纳入健康知识普及原则的战略成功地减少了再入院。这一点尤其重要，因为医疗补助和医疗保险服务中心（CMS）最近开始对调整后的再入院率高于全国平均水平的急性心肌梗死（AMI），心力衰竭（HF）和肺炎的医院进行处罚。迄今为止，CMS使用的调整后费率仅包括医疗合并症和年龄。虽然处罚的目的是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应有的负担，因为这些医院为健康素养低的风险最大的患者提供服务，并且更有可能与自我斗争。 关怀活动。根据健康知识普及情况进行调整，将确保处罚公平，并确定最需要健康知识普及举措的医院。 通过这项研究，我们将证明，一个派生的健康素养措施，可以估计每个217,740人口普查块组在美国使用兰德预测模型。通过将健康素养估计与约30万名医疗保险受益人的全国队列联系起来，我们将证明估计的预测能力。然后，我们将把健康素养估计值与约176，000名患有AMI的医疗保险患者的全国队列联系起来，以检查健康素养对AMI再入院的影响。最后，我们将使用健康素养估计值来增强调整后的AMI再入院率的CMS分析模型（临床分析收缩估计和风险调整）。我们的具体目标是：1a）估计并绘制美国每个人口普查区块组的平均健康素养得分，1b）检查健康素养估计值与临床终点结果复合数据之间的关系（死亡率、HF、AMI、中风、终末期肾病），2）调查健康素养估计对约176人的全国队列中30天再入院的影响，000名AMI患者和3）比较美国各医院的国家医疗保险AMI队列中，调整和不调整衍生健康素养评分的风险标准化再入院率，States.

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.