Health Literacy, Hospital Discharge, and Cardiovascular Outcomes

项目摘要 出院后的这段时间是病人的脆弱时期，在这段时间里， 和药物管理不善是常见的。出院前后的护理不佳， 可预防的不良事件、再入院和更高的死亡率，特别是在高危情况下， 急性冠状动脉综合征（ACS）健康知识普及率低是不良流程的普遍风险因素， 虽然卫生知识普及对保健的成果有重要影响，但对卫生知识普及在这一高风险环境中的作用几乎没有进行过研究。 本研究的目的是检查健康素养和其他患者特征如何影响 出院质量和住院后相关结局。我们将测试一个概念框架 包括患者，提供者和系统相关因素作为这些因素的潜在中介和调节者 关系。具体目标是： 1)确定健康素养与出院质量的关系，包括影响 关于沟通、出院准备和随后的药物管理。 2)检查健康素养和出院质量对功能状态、健康状况、 相关的生活质量，以及出院后30天和90天的计划外医疗保健利用。 3)探讨健康素养与出院品质对住院后死亡率之影响。 我们将对3,000名因ACS住院并出院回家的成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， 护理的过程和结果。在住院期间，我们将管理一组经过验证的 社会人口学、教育、认知、心理、文化和行为测量。目标1： 出院后2-3天通过电话访问患者，评估出院质量，包括 病人与医疗服务提供者之间的沟通和出院准备措施。对于目标2，我们将审查 出院后30天和90天通过电话访问患者，以评估 功能状态、健康相关的生活质量和计划外的医疗保健利用，包括急诊 部门访问和再住院。对于目标3，我们将使用社会保障来确定死亡率， 给药死亡主文件，入组后随访患者长达3.5年。我们将使用 多变量路径分析和生存分析，以模拟健康之间的直接和间接关系 识字率、其他衡量因素、潜在的中介者或调节者，以及每个感兴趣的结果。 这项跨学科的研究将大大提高我们对健康素养如何影响医院的理解 出院过程和住院后的结局。研究结果将使我们能够更好地设计干预措施 改善对健康知识水平低的病人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疾病的结果，减少与识字有关的健康差距。

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.