title: Association between health literacy and 30-day healthcare use after hospital discharge in the heart failure population.
abstract: Low health literacy increases the risk for hospital readmissions. Despite this, the measurement and use of health literacy to guide discharge counseling and planning in heart failure patients is not commonly performed. A short 3-Question Brief Health Literacy Screen (BHLS) is available and takes less than three minutes to complete, but has never been evaluated to help determine whether health literacy affects healthcare use after discharge in patients with heart failure.
  
  
  
  The purpose of this study was to assess 30-day readmissions and emergency department visits based on health literacy evaluated by the BHLS in an acute care heart failure population.
  
  
  
  This was a prospective observational cohort study conducted at a large quaternary health system. Hospitalized patients with a diagnosis of heart failure were assessed for health literacy using the BHLS. Unplanned healthcare use after discharge including 30-day, all-cause ED visits and hospital readmissions was assessed using univariate and logistic regression models.
  
  
  
  Two hundred and sixty four patients aged 66.6 ± 14.3 (mean ± SD) years met inclusion/exclusion criteria of whom 175 (66.3%) had a BHLS score >9 (adequate health literacy) and 89 (33.7%) had a BHLS score ≤9 (low health literacy). Predictors of low health literacy included older age (p = 0.019), lower education level (p < 0.001) and unemployed (p = 0.048). After controlling for potential confounders, low health literacy was independently associated with 30-day healthcare use after hospital discharge (OR:1.80; 95% CI: 1.04-3.11; p = 0.035).
  
  
  
  Using a short, 3-question validated survey instrument, it was demonstrated that low health literacy was associated with increased 30-day unplanned healthcare use after discharge in this heart failure population. These results provide a clinically useful, easily incorporated tool that could identify high-risk patients at need for clinical interventions.
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA; University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA. Electronic address: sarah.cox127@gmail.com.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Cox
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA. Electronic address: mliebl@houstonmethodist.org.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Liebl
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA. Electronic address: meghanmccomb@yahoo.com.
authors.forename: Meghan N
authors.initials: MN
authors.lastname: McComb
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA. Electronic address: jqchau@icloud.com.
authors.forename: Jason Q
authors.initials: JQ
authors.lastname: Chau
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA. Electronic address: awilson@houstonmethodist.org.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Wilson
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA. Electronic address: machi@houstonmethodist.org.
authors.forename: May
authors.initials: M
authors.lastname: Achi
authors.affiliation: University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA. Electronic address: kgarey@uh.edu.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
authors.affiliation: University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA. Electronic address: DWallace@uh.edu.
authors.forename: David
authors.initials: D
authors.lastname: Wallace
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006295:Health Resources / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas; D013997:Time Factors
keywords: Cohort study; Health literacy; Hospital re-admissions; Medication safety; Prospective evaluation