The roles of low literacy and social support in predicting the preventability of hospital admission.
BACKGROUND
Prior studies found higher hospitalization rates among patients with low literacy, but did not determine the preventability of these admissions or consider other determinants of hospitalization, such as social support. This study evaluated whether low literacy was a predictor for preventability of hospitalization when considered in the context of social support, sociodemographics, health status, and risk behaviors.


METHODS
A convenience sample of 400 patients, admitted to general medicine wards in a university-affiliated Veterans Affairs hospital between August 1, 2001 and April 1, 2003, completed a face-to-face interview to assess literacy, sociodemographics, social support, health status, and risk behaviors. Two Board-certified Internists independently assessed preventability of hospitalization and determined the primary preventable cause through blinded medical chart reviews.


RESULTS
Neither low literacy (<seventh grade) nor very low literacy (<fourth grade) was significantly associated with preventability of hospitalization. In multivariable analysis, significant predictors of having a preventable cause of hospitalization included binge alcohol drinking (P< or =.001), lower social support for medical care (P<.04), < or =3 annual clinic visits (P<.005), and > or =12 people talked to weekly (P<.023). Among nonbinge drinkers with lower social support for medical care, larger social networks were predictive of preventability of hospitalization. Among nonbinge drinkers with higher support for medical care, lower outpatient utilization was predictive of the preventability of hospitalization.


CONCLUSIONS
While low literacy was not predictive of admission preventability, the formal assessment of alcohol binge drinking, social support for medical care, social network size, and prior outpatient utilization may enhance our ability to predict the preventability of hospitalizations and develop targeted interventions.
Arozullah
Ahsan M
AM
Jesse Brown VA Medical Center, Chicago, IL 60612, USA. arozulla@uic.edu
Lee
Shoou-Yih D
SY
Khan
Taha
T
Kurup
Sindhu
S
Ryan
Jeffrey
J
Bonner
Michael
M
Soltysik
Robert
R
Yarnold
Paul R
PR
D000368:Aged; D000437:Alcoholism; D000553:Ambulatory Care / Q000706:statistics & numerical data; D004522:Educational Status; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D015999:Multivariate Analysis; D012944:Social Support