title: The Impact of Health Literacy and Clinicodemographic Factors on Use of Discharge Services after Radical Cystectomy.
abstract: There are few data on the relationship between health literacy and discharge disposition. We hypothesized that patient discharge needs after radical cystectomy are affected by health literacy.
  
  
  
  We identified 504 patients who underwent radical cystectomy and completed the validated BHLS (Brief Health Literacy Screen) after November 2010. Bivariate and logistic regression analyses were performed to determine whether health literacy is associated with the use of discharge resources after radical cystectomy.
  
  
  
  Of patients treated with radical cystectomy 50.6% required discharge services and had lower health literacy (BHLS 11.9 vs 12.5, p = 0.016) than patients discharged home without services. On multivariable analysis older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002), female gender (OR 2.3, 95% CI 1.2-4.4, p = 0.019), body mass index (OR 1.1, 95% CI 1.0-1.1, p = 0.034), Charlson comorbidity index score (OR 1.1, 95% CI 1.0-1.2, p = 0.037) and length of stay (OR 1.1, 95% CI 1.0-1.2, p = 0.019) were significantly associated with the use of discharge resources. Patients with continent vs incontinent urinary diversion were less likely to require discharge services (OR 0.4, 95% CI 0.2-0.8, p = 0.013).
  
  
  
  Older age, female gender, body mass index, comorbidities, length of stay and incontinent diversion are associated with increased use of discharge resources after radical cystectomy. Low health literacy may affect patient discharge disposition but it was not significant on multivariable analysis. Factors that influence the complex self-care required of patients after cystectomy should be considered during discharge planning.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Kappa
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Scarpato
authors.affiliation: Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Goggins
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: kelvin.a.moses@vanderbilt.edu.
authors.forename: Kelvin A
authors.initials: KA
authors.lastname: Moses
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015653:Cystectomy; D005260:Female; D057220:Health Literacy; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012648:Self Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion
keywords: cystectomy; health literacy; health resources; self care; urinary bladder