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Espinosa CG, Vergez S, McDonald MV, Safford MM, Cho J, Tobin JN, Mourad O, Marcus R, Joanna Bryan Ringel J, Banerjee S, Dell N, Feldman P, Sterling MR. Leveraging home health aides to improve outcomes in heart failure: A pilot study protocol. Contemp Clin Trials 2024; 143:107570. [PMID: 38740297 PMCID: PMC11283941 DOI: 10.1016/j.cct.2024.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/07/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.(1, 2) Despite a decade of innovation, the majority of interventions aimed at reducing hospitalization and readmissions in HF have not been successful.(3-7) One reason may be that most have overlooked the role of home health aides and attendants (HHAs), who are often highly involved in HF care.(8-13) Despite their contributions, studies have found that HHAs lack specific HF training and have difficulty reaching their nursing supervisors when they need urgent help with their patients. Here we describe the protocol for a pilot randomized control trial (pRCT) assessing a novel stakeholder-engaged intervention that provides HHAs with a) HF training (enhanced usual care arm) and b) HF training plus a mobile health application that allows them to chat with a nurse in real-time (intervention arm). In collaboration with the VNS Health of New York, NY, we will conduct a single-site parallel arm pRCT with 104 participants (HHAs) to evaluate the feasibility, acceptability, and effectiveness (primary outcomes: HF knowledge; HF caregiving self-efficacy) of the intervention among HHAs caring for HF patients. We hypothesize that educating and better integrating HHAs into the care team can improve their ability to provide support for patients and outcomes for HF patients as well (exploratory outcomes include hospitalization, emergency department visits, and readmission). This study offers a novel and potentially scalable way to leverage the HHA workforce and improve the outcomes of the patients for whom they care. Clinical trial.gov registration: NCT04239911.
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Affiliation(s)
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | - Jacklyn Cho
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Omar Mourad
- Weill Cornell Medicine- Qatar, Qatar Foundation - Education City, Doha, Qatar
| | - Rosa Marcus
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | | | - Penny Feldman
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
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Nair D, Schildcrout JS, Prigmore HL, Greevy R, Trochez RJ, Bachmann JM, Umeukeje EM, Fissell RB, Taylor WD, Kripalani S, Cavanaugh KL. Health Competence Is a Determinant of Exercise Frequency in Older Adults With CKD. Kidney Int Rep 2024; 9:2567-2570. [PMID: 39156163 PMCID: PMC11328564 DOI: 10.1016/j.ekir.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 08/20/2024] Open
Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
- Veterans Affairs Tennessee Valley Health System, Nashville, Tennessee, USA
| | - Jonathan S. Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heather L. Prigmore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo J. Trochez
- Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
| | - Justin M. Bachmann
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ebele M. Umeukeje
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
| | - Rachel B. Fissell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kerri L. Cavanaugh
- Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
- Veterans Affairs Tennessee Valley Health System, Nashville, Tennessee, USA
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Vasilevskis EE, Trumbo SP, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Simmons SF. Medication Discrepancies among Older Hospitalized Adults Discharged from Post-Acute Care Facilities to Home. J Am Med Dir Assoc 2024; 25:105017. [PMID: 38754476 PMCID: PMC11335011 DOI: 10.1016/j.jamda.2024.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of medication discrepancies among hospitalized older adults transitioning from PAC to home. DESIGN A nested cohort analysis. SETTING AND PARTICIPANTS Included participants enrolled in a patient-centered deprescribing trial, for patients (aged ≥50 years and taking at least 5 medications) transitioning from one of 22 PACs to home. METHODS We assessed demographic and medication measures at the initial hospitalization. The primary outcome measure was medication discrepancies, with the PAC discharge list serving as reference for comparison to the participant's self-reported medication list at 7 days following PAC discharge. Discrepancies were categorized as additions, omissions, and dose discrepancies and were organized by common medication classes and risk of harm (eg, 2015 Beers Criteria). Ordinal logistic regression assessed for patient risk factors for PAC discharge discrepancy count. RESULTS A total of 184 participants had 7-day PAC discharge medication data. Participants were predominately female (67%) and Caucasian (83%) with a median of 16 prehospital medications [interquartile range (IQR) 11, 20]. At the 7-day follow-up, 98% of participants had at least 1 medication discrepancy, with a median number of 7 medication discrepancies (IQR 4, 10) per person, 4 (IQR 2, 6) of which were potentially inappropriate medications as defined by the Beers Criteria. Higher medication discrepancies at index hospital admission and receipt of caregiver assistance with medications were 2 key predictors of medication discrepancies in the week after PAC discharge to home. CONCLUSIONS AND IMPLICATIONS Older patients transitioning home from a PAC facility are at high risk for medication discrepancies. This study underscores the need for interventions targeted at this overlooked transition period, especially as patients resume responsibility for managing their own medications after both a hospital and PAC stay.
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Affiliation(s)
- Eduard Eric Vasilevskis
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Silas P Trumbo
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Avantika Saraf Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Kay Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Sandra Faye Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Nair D, Schildcrout JS, Shi Y, Trochez R, Nwosu S, Bell SP, Mixon AS, Welch SA, Goggins K, Bachmann JM, Vasilevskis EE, Cavanaugh KL, Rothman RL, Kripalani SB. Patient-reported predictors of postdischarge mortality after cardiac hospitalization. J Hosp Med 2024; 19:475-485. [PMID: 38560772 PMCID: PMC11147709 DOI: 10.1002/jhm.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adults hospitalized for cardiovascular events are at high risk for postdischarge mortality. Screening of psychosocial risk is prioritized by the Joint Commission. We tested whether key patient-reported psychosocial and behavioral measures could predict posthospitalization mortality in a cohort of adults hospitalized for a cardiovascular event. METHODS We conducted a prospective cohort study to test the prognostic utility of validated patient-reported measures, including health literacy, social support, health behaviors and disease management, and socioeconomic status. Cox survival analyses of mortality were conducted over a median of 3.5 years. RESULTS Among 2977 adults hospitalized for either acute coronary syndrome or acute decompensated heart failure, the mean age was 53 years, and 60% were male. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unemployed (hazard ratio [HR]: 1.99, 95% confidence interval [CI]): 1.30-3.06), retired (HR: 2.14, 95% CI: 1.60-2.87), or unable to work due to disability (HR: 2.36, 95% CI: 1.73-3.21), as compared to those who were employed. Patient-reported perceived health competence (PHCS-2) and exercise frequency were also associated with mortality risk after adjusting for all other variables (HR: 0.86, 95% CI: 0.73-1.00 per four-point increase in PHCS-2; HR: 0.86, 95% CI: 0.77-0.96 per 3-day increase in exercise frequency, respectively). CONCLUSIONS Patient-reported measures of employment status, perceived health competence, and exercise frequency independently predict mortality after a cardiac hospitalization. Incorporating these brief, valid measures into hospital-based screening may help with prognostication and targeting patients for resources during post-discharge transitions of care.
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Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee
- Vanderbilt Center for Health Services Research, Nashville, Tennessee
| | | | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ricardo Trochez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan P. Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Sarah A. Welch
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Goggins
- Vanderbilt Center for Health Services Research, Nashville, Tennessee
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M. Bachmann
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eduard E. Vasilevskis
- Vanderbilt Center for Health Services Research, Nashville, Tennessee
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee
- Center for Clinical Quality and Implementation Research, VUMC, Nashville, TN
| | - Kerri L. Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee
- Vanderbilt Center for Health Services Research, Nashville, Tennessee
| | - Russell L. Rothman
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil B. Kripalani
- Vanderbilt Center for Health Services Research, Nashville, Tennessee
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Clinical Quality and Implementation Research, VUMC, Nashville, TN
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Trochez RJ, Barrett JB, Shi Y, Schildcrout JS, Rick C, Nair D, Welch SA, Kumar AA, Bell SP, Kripalani S. Vulnerability to functional decline is associated with noncardiovascular cause of 90-day readmission in hospitalized patients with heart failure. J Hosp Med 2024; 19:386-393. [PMID: 38402406 DOI: 10.1002/jhm.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Hospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions. OBJECTIVES We examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure. DESIGNS, SETTINGS, AND PARTICIPANTS This prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study. MAIN OUTCOME AND MEASURES The primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES-13). RESULTS Among 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR] = 1.36, 95% confidence interval [CI]: 1.06-1.75) in the first 90 days after discharge. The VES-13 score was not associated with readmission for cardiovascular causes (RRR = 0.94, 95% CI: 0.75-1.17). CONCLUSIONS Vulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES-13 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.
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Affiliation(s)
- Ricardo J Trochez
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer B Barrett
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chelsea Rick
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Devika Nair
- Department of Medicine, Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah A Welch
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center(GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Anupam A Kumar
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Department of Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Bindhu S, Nattam A, Xu C, Vithala T, Grant T, Dariotis JK, Liu H, Wu DTY. Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review. Online J Public Health Inform 2024; 16:e50898. [PMID: 38506914 PMCID: PMC10993137 DOI: 10.2196/50898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities. OBJECTIVE This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy. METHODS The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions. RESULTS The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself. CONCLUSIONS The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients.
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Affiliation(s)
- Shwetha Bindhu
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Anunita Nattam
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Catherine Xu
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Tripura Vithala
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Tiffany Grant
- University of Cincinnati Libraries Research and Data Services, University of Cincinnati, Cincinnati, OH, United States
| | - Jacinda K Dariotis
- Department of Human Development and Family Studies, The University of Illinois at Urbana-Champaign, Urbana, IL, United States
- The Family Resiliency Center, College of Agricultural, Consumer and Environmental Sciences, The University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Biomedical and Translational Sciences, The University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Hexuan Liu
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, United States
| | - Danny T Y Wu
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Holmen H, Flølo T, Tørris C, Løyland B, Almendingen K, Bjørnnes AK, Albertini Früh E, Grov EK, Helseth S, Kvarme LG, Malambo R, Misvær N, Rasalingam A, Riiser K, Sandbekken IH, Schippert AC, Sparboe-Nilsen B, Sundar TKB, Sæterstrand T, Utne I, Valla L, Winger A, Torbjørnsen A. Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:36. [PMID: 38248501 PMCID: PMC10815593 DOI: 10.3390/ijerph21010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Intervention Centre, Oslo University Hospital, 4950 Oslo, Norway
| | - Tone Flølo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Surgery, Voss Hospital, Haukeland University Hospital, 5704 Voss, Norway
| | - Christine Tørris
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Rosah Malambo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Anurajee Rasalingam
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Ida Hellum Sandbekken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ana Carla Schippert
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Turid Kristin Bigum Sundar
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Torill Sæterstrand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), 0484 Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
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Nair D, Schildcrout JS, Shi Y, Trochez R, Nwosu S, Bell SP, Mixon AS, Welch SA, Goggins K, Bachmann JM, Vasilevskis EE, Cavanaugh KL, Rothman RL, Kripalani SB. Patient-reported predictors of post-discharge mortality after cardiac hospitalization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296460. [PMID: 37873096 PMCID: PMC10593012 DOI: 10.1101/2023.10.02.23296460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Adults hospitalized for cardiovascular events are at high risk for post-discharge mortality. Hospital-based screening of health-related psychosocial risk factors is now prioritized by the Joint Commission and the National Quality Forum to achieve equitable, high-quality care. We tested our hypothesis that key patient-reported psychosocial and behavioral measures could predict post-hospitalization mortality in a cohort of adults hospitalized for a cardiovascular event. Methods This was a prospective cohort of adults hospitalized at Vanderbilt University Medical Center. Validated patient-reported measures of health literacy, social support, disease self-management, and socioeconomic status were used as predictors of interest. Cox survival analyses of mortality were conducted over a median 3.5-year follow-up (range: 1.25 - 5.5 years). Results Among 2,977 adults, 1,874 (63%) were hospitalized for acute coronary syndrome and 1,103 (37%) were hospitalized for acute decompensated heart failure; 60% were male; and the mean age was 53 years. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unable to work due to disability (Hazard Ratio (HR) 2.36, 95% Confidence Interval (CI): 1.73-3.21), who were retired (HR 2.14, 95% CI 1.60-2.87), and who reported unemployment (HR 1.99, 95% CI 1.30-3.06) as compared to those who were employed. Patient-reported measures of disease self-management, perceived health competence and exercise frequency, were also associated with mortality risk after full covariate adjustment (HR 0.86, 95% CI 0.73-1.00 per four-point increase), (HR 0.86, 95% CI 0.77-0.96 per three-day change), respectively. Conclusions Patient-reported measures of employment status independently predict post-discharge mortality after a cardiac hospitalization. Measure of disease self-management also have prognostic modest utility. Hospital-based screening of psychosocial risk is increasingly prioritized in legislative policy. Incorporating brief, valid measures of employment status and disease self-management factors may help target patients for psychosocial, financial, and rehabilitative resources during post-discharge transitions of care.
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Petersen AGP, Kolankiewicz ACB, Casagrande D, Pluta P, Winter VDB, de Carvalho FF, Tronco CS. Weaknesses in the Continuity of Care of Puerperal Women: An Integrative Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e415-e421. [PMID: 37595599 PMCID: PMC10438967 DOI: 10.1055/s-0043-1772185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/27/2023] [Indexed: 08/20/2023] Open
Abstract
The aim of the present study was to identify how the transition of care from the hospital to the community occurs from the perspective of puerperal women at risk. An integrative literature review was performed, with the question: "How does the transition of care for at-risk puerperal women from the hospital to the community occur?" The search period ranged from 2013 to 2020, in the following databases: PubMed, LILACS, SciELO, and Scopus. MESH, DeCS and Boolean operators "OR" and "AND" are used in the following crossover analysis: patient transfer OR transition care OR continuity of patient care OR patient discharge AND postpartum period, resulting in 6 articles. The findings denote discontinuity of care, given the frequency of non-adherence to the puerperal consultation. Transition studies of care in the puerperium were not found, which requires proposing new studies.
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Affiliation(s)
| | | | - Denise Casagrande
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
| | - Pâmella Pluta
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
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10
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Hu JR, Huang S, Bosworth HB, Freedland KE, Mayberry LS, Kripalani S, Wallston KA, Roumie CL, Bachmann JM. Association of Perceived Health Competence With Cardiac Rehabilitation Initiation. J Cardiopulm Rehabil Prev 2023; 43:93-100. [PMID: 36730182 PMCID: PMC9974554 DOI: 10.1097/hcr.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceived health competence with CR initiation among patients hospitalized for acute coronary syndrome (ACS) after adjusting for demographic, clinical, and psychosocial characteristics. METHODS The Vanderbilt Inpatient Cohort Study (VICS) characterized the effect of psychosocial characteristics on post-discharge outcomes in ACS inpatients hospitalized from 2011 to 2015. The primary outcome for this analysis was participation in an outpatient CR program. The primary predictor was the two-item Perceived Health Competence Scale (PHCS-2), which yields a score from 2 to 10 (higher scores indicate greater perceived health competence). Multiple logistic regression was used to evaluate the relationship between the PHCS-2 and CR initiation. RESULTS A total of 1809 VICS participants (median age: 61 yr, 39% female) with ACS were studied, of whom 294 (16%) initiated CR. The PHCS-2 was associated with a higher odds of CR initiation (OR = 1.15/point increase: 95% CI, 1.06-1.26, P = .001) after adjusting for covariates. Participants with comorbid heart failure had a lower odds of CR initiation (OR = 0.31: 95% CI, 0.16-0.60, P < .001) as did current smokers (OR = 0.64: 95% CI, 0.43-0.96, P = .030). CONCLUSION Perceived health competence is associated with outpatient CR initiation in patients hospitalized with ACS. Interventions designed to support perceived health competence may be useful for improving CR participation.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Hu); Departments of Biostatistics (Dr Huang) and Medicine (Drs Mayberry, Kripalani, Roumie, and Bachmann), Vanderbilt University Medical Center, Nashville, Tennessee; Departments of Population Health Sciences and Medicine, Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (Dr Bosworth); Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri (Dr Freedland); Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee (Drs Mayberry, Kripalani, Wallston, Roumie and Bachmann); and Medicine Service, Veterans Affairs Tennessee Valley Healthcare System-Nashville Campus, Nashville, Tennessee (Drs Roumie and Bachmann)
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11
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Movement is Life-Optimizing Patient Access to Total Joint Arthroplasty: Housing Security and Discharge Planning Disparities. J Am Acad Orthop Surg 2022; 30:1079-1082. [PMID: 35353752 DOI: 10.5435/jaaos-d-21-00943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/23/2022] [Indexed: 02/01/2023] Open
Abstract
Patients undergoing total joint arthroplasty should be screened for housing insecurity. Housing insecurity in the United States ranges from 10% to 15%, which is predisposed to those who are low-income, racial minorities, and unmarried. Osteoarthritic pain has a notable effect on function and quality of life and may prevent many individuals from continuing with their jobs. There is an inexorable, cyclic, structurally reinforced relationship between housing and health: where chronic illness affects housing security leading to issues with access to care and ultimately issues with health status. Housing insecurity is currently an imposed barrier to surgery. However, creative solutions exist to address housing insecurity, such as insurance company waivers, community resources (eg, churches) and organizations (eg, Meals on Wheels), halfway houses, and temporary housing (eg, hotels). Optimization for discharge planning in these vulnerable populations includes short-term stay in rehabilitation or skilled nursing facilities, home health services, or outpatient therapy.
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Heudel PE, Delrieu L, Dumas E, Crochet H, Hodroj K, Charrier I, Chvetzoff G, Durand T, Blay JY. Impact of Limited E-Health Literacy on the Overall Survival of Patients With Cancer. JCO Clin Cancer Inform 2022; 6:e2100174. [PMID: 35213209 PMCID: PMC8887947 DOI: 10.1200/cci.21.00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Digitalization of the health care system is transforming cancer patient care. Although many studies have investigated the determinants of a limited digital health literacy, the association between frailty factors and overall survival (OS) of these patients has never been assessed. METHODS A retrospective noninterventional study included 15,244 adult patients with cancer diagnosed between January 1, 2015, and December 31, 2017, and treated at the Centre Léon Bérard. Limited e-health literacy was defined as the absence of an e-mail address in the electronic patient record. An Inverse Probability of Treatment-Weighted Kaplan-Meier estimate and a multivariate Cox proportional hazards model including interaction terms were used to adjust for confounding on measured covariates. RESULTS In total, 15,244 adults with cancer were included: 55% women, with a median age of 62 years (19-103), and 35.5% had a metastatic disease. More than half (n = 8,771, 57.5%) had entered their e-mail address in their electronic patient record, and 4,020 (26.4%) opened their own patient portal. The median follow-up was 3.6 years (range: 0-6.8). Inverse Probability of Treatment-weighted Kaplan-Meier estimates showed a significantly better OS for patients with an e-mail address (P < .001). In multivariate analysis integrating interaction terms, male gender (hazard ratio [HR] = 1.27; 95% CI, 1.15 to 1.41; P < .001), older age (HR = 1.02; 95% CI, 1.02 to 1.03; P < .001), de novo metastatic setting (HR = 2.63; 95% CI, 2.47 to 2.79; P < .001), and no e-mail address (HR = 1.63; 95% CI, 1.33 to 2.00; P < .001) were significantly associated with worse OS. CONCLUSION Our results support a strong association between the limited level of literacy and OS. A more in-depth study integrating variables such as socioeconomic level and location of residence would enrich these results.
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Affiliation(s)
- Pierre E. Heudel
- Department of Medical Oncology, Center Léon Bérard, Lyon, France,Pierre E. Heudel, MD, MSc, LLM, Department of Medical Oncology, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France; e-mail:
| | - Lidia Delrieu
- Residual Tumor and Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France
| | - Elise Dumas
- Residual Tumor and Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France,MINES ParisTech, PSL Research University, CBIO-Center for Computational Biology, Paris, France,INSERM, U900, Paris, France
| | - Hugo Crochet
- Data and Artificial Intelligence Team, Center Léon Bérard, Lyon, France
| | - Khalil Hodroj
- Department of Medical Oncology, Center Léon Bérard, Lyon, France
| | | | - Gisèle Chvetzoff
- Departement of Supportive Care, Léon Bérard Cancer Center, Lyon, France
| | - Thierry Durand
- Department of Hospital Information, Léon Bérard Cancer Center, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard, Lyon, France
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King C, Collins D, Patten A, Nicolaidis C, Englander H. Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study. J Addict Med 2022; 16:41-48. [PMID: 33577229 PMCID: PMC8349928 DOI: 10.1097/adm.0000000000000819] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trust is essential in patient-physician relationships. Hospitalized patients with substance use disorders (SUDs) often experience stigma and trauma in the hospital, which can impede trust. Little research has explored the role of hospital-based addictions care in creating trusting relationships with patients with SUDs. This study describes how trust in physicians changed among hospitalized people with SUDs who were seen by an interprofessional addiction medicine service. METHODS We analyzed data from hospitalized patients with SUD seen by an addiction consult service from 2015 to 2018. Participants completed surveys at baseline and 30 to 90 days after hospital discharge. Follow-up assessments included open-ended questions exploring participant experiences with hospitalization and the addiction consult service. We measured provider trust using the Wake Forest Trust scale. We modeled trust trajectories using discrete mixture modeling, and sampled qualitative interviews from those trust trajectories. RESULTS Of 328 participants with SUD who had prior hospitalizations but had not previously been seen by an addiction consult service, 196 (59.8%) had both baseline and follow-up trust scores. We identified 3 groups of patients: Persistent-Low Trust, Increasing Trust, and Persistent-High Trust and 4 qualitative themes around in-hospital trust: humanizing care, demonstrating addiction expertise, reliability, and granting agency. CONCLUSIONS Most participants retained or increased to high trust levels after hospitalization with an addiction consult service. Addiction consult services can create environments where healthcare providers build trust with, and humanize care for, hospitalized patients with SUD, and can also mitigate power struggles that hospitalized patients with SUD frequently experience.
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Affiliation(s)
- Caroline King
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Alisa Patten
- Department of Medicine, Oregon Health & Science University
| | - Christina Nicolaidis
- Department of Medicine, Oregon Health & Science University
- School of Social Work, Portland State University
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Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E, Brown TM, Nguyen OK, Goyal P. Social Determinants of Health and 30-Day Readmissions Among Adults Hospitalized for Heart Failure in the REGARDS Study. Circ Heart Fail 2022; 15:e008409. [PMID: 34865525 PMCID: PMC8849604 DOI: 10.1161/circheartfailure.121.008409] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND It is not known which social determinants of health (SDOH) impact 30-day readmission after a heart failure (HF) hospitalization among older adults. We examined the association of 9 individual SDOH with 30-day readmission after an HF hospitalization. METHODS AND RESULTS Using the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), we included Medicare beneficiaries who were discharged alive after an HF hospitalization between 2003 and 2014. We assessed 9 SDOH based on the Healthy People 2030 Framework: race, education, income, social isolation, social network, residential poverty, Health Professional Shortage Area, rural residence, and state public health infrastructure. The primary outcome was 30-day all-cause readmission. For each SDOH, we calculated incidence per 1000 person-years and multivariable-adjusted hazard ratios of readmission. Among 690 participants, the median age was 76 years at hospitalization (interquartile range, 71-82), 44.3% were women, 35.5% were Black, 23.5% had low educational attainment, 63.0% had low income, 21.0% had zip code-level poverty, 43.5% resided in Health Professional Shortage Areas, 39.3% lived in states with poor public health infrastructure, 13.1% were socially isolated, 13.3% had poor social networks, and 10.2% lived in rural areas. The 30-day readmission rate was 22.4%. In an unadjusted analysis, only Health Professional Shortage Area was significantly associated with 30-day readmission; in a fully adjusted analysis, none of the 9 SDOH were individually associated with 30-day readmission. CONCLUSIONS In this modestly sized national cohort, although prevalent, none of the SDOH were associated with 30-day readmission after an HF hospitalization. Policies or interventions that only target individual SDOH to reduce readmissions after HF hospitalizations may not be sufficient to prevent readmission among older adults.
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Affiliation(s)
- Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, A.L
| | - Erica Phillips
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Todd M. Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, A.L
| | - Oanh K. Nguyen
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, CA
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY., Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY
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Variability in skilled nursing facility screening and admission processes: Implications for value-based purchasing. Health Care Manage Rev 2021; 45:353-363. [PMID: 30418292 DOI: 10.1097/hmr.0000000000000225] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitalized older adults are increasingly admitted to skilled nursing facilities (SNFs) for posthospital care. However, little is known about how SNFs screen and evaluate potential new admissions. In an era of increasing emphasis on postacute care outcomes, these processes may represent an important target for interventions to improve the value of SNF care. PURPOSE The aim of this study was to understand (a) how SNF clinicians evaluate hospitalized older adults and make decisions to admit patients to an SNF and (b) the limitations and benefits of current practices in the context of value-based payment reforms. METHODS We used semistructured interviews to understand the perspective of 18 clinicians at three unique SNFs-including physicians, nurses, therapists, and liaisons. All transcripts were analyzed using a general inductive theme-based approach. RESULTS We found that the screening and admission processes varied by SNF and that variability was influenced by three key external pressures: (a) inconsistent and inadequate transfer of medical documentation, (b) lack of understanding among hospital staff of SNF processes and capabilities, and (c) hospital payment models that encouraged hospitals to discharge patients rapidly. Responses to these pressures varied across SNFs. For example, screening and evaluation processes to respond to these pressures included gaining access to electronic medical records, providing inpatient physician consultations prior to SNF acceptance, and turning away more complex patients for those perceived to be more straightforward rehabilitation patients. CONCLUSIONS We found facility behavior was driven by internal and external factors with implications for equitable access to care in the era of value-based purchasing. PRACTICE IMPLICATIONS SNFs can most effectively respond to these pressures by increasing their agency within hospital-SNF relationships and prioritizing more careful patient screening to match patient needs and facility capabilities.
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Hudson T. The Role of Social Determinates of Health in Discharge Practices. Nurs Clin North Am 2021; 56:369-378. [PMID: 34366157 DOI: 10.1016/j.cnur.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Major risks associated with inadequate discharge preparation and execution include medication errors, adverse drug events, and hospital readmissions. Nurses must develop pertinent skills to assess how the social environment impacts patients' likelihood of a safe and healthy transition back into the community as they prepare patients for discharge. Recognition and consideration of social determinants of health are critical to minimizing health disparities, enhancing health equity and supporting positive patient outcomes. Examples of strategies for enhanced discharge practices include implicit bias assessment and training, screening for food insecurity, and assessment for quality referral sources.
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Affiliation(s)
- Tamika Hudson
- Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA.
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Fabbri M, Murad MH, Wennberg AM, Turcano P, Erwin PJ, Alahdab F, Berti A, Manemann SM, Yost KJ, Finney Rutten LJ, Roger VL. Health Literacy and Outcomes Among Patients With Heart Failure: A Systematic Review and Meta-Analysis. JACC-HEART FAILURE 2021; 8:451-460. [PMID: 32466837 DOI: 10.1016/j.jchf.2019.11.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF). BACKGROUND Growing evidence suggests an association between health literacy and health-related outcomes in patients with HF. METHODS We searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies. RESULTS We included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy. CONCLUSIONS In this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
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Affiliation(s)
- Matteo Fabbri
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Fares Alahdab
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Alvise Berti
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Kostelanetz S, Di Gravio C, Schildcrout JS, Roumie CL, Conway D, Kripalani S. Should We Implement Geographic or Patient-Reported Social Determinants of Health Measures In Cardiovascular Patients. Ethn Dis 2021; 31:9-22. [PMID: 33519151 DOI: 10.18865/ed.31.1.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare patient-reported social determinants of health (SDOH) to the Brokamp Area Deprivation Index (ADI), and evaluate the association of patient-reported SDOH and ADI with mortality in patients with cardiovascular disease (CVD). Design Prospective cohort. Setting Academic medical center. Participants Adults with acute coronary syndrome (ACS) and/or acute exacerbation of heart failure (HF) hospitalized between 2011 and 2015. Methods Patient-reported SDOH included: income range, education, health insurance, and household size. ADI was calculated using census tract level variables of poverty, median income, high school completion, lack of health insurance, assisted income, and vacant housing. Primary Outcome All-cause mortality, up to 5 years follow-up. Results The sample was 60% male, 84% White, and 93% insured; mean patient-reported household income was $48,000 (SD $34,000). ADI components were significantly associated with corresponding patient-reported variables. In age, sex, and race adjusted Cox regression models, ADI was associated with mortality for ACS (HR 1.23, 95% CI 1.06, 1.42), but not HF (HR 1.09, 95% CI .99, 1.21). Mortality models for ACS improved with consideration of social determinants data (C-statistics: base demographic model=.612; ADI added=.644; patient-reported SDOH added=.675; both ADI and patient-reported SDOH added=.689). HF mortality models improved only slightly (C-statistics: .600, .602, .617, .620, respectively). Conclusions The Brokamp ADI is associated with mortality in hospitalized patients with CVD. In the absence of available patient-reported data, hospitals could implement the Brokamp ADI as an approximation for patient-reported data to enhance risk stratification of patients with CVD.
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Affiliation(s)
- Sophia Kostelanetz
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Chiara Di Gravio
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | | | - Christianne L Roumie
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Douglas Conway
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Kripalani S, Goggins K, Couey C, Yeh VM, Donato KM, Schnelle JF, Wallston KA. Disparities in Research Participation by Level of Health Literacy. Mayo Clin Proc 2021; 96:314-321. [PMID: 33549253 PMCID: PMC7874435 DOI: 10.1016/j.mayocp.2020.06.058] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/09/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine at which phase in the recruitment process for participation in clinical research studies do health literacy and other patient characteristics influence recruitment outcomes. PATIENTS AND METHODS Using a sample of 5872 patients hospitalized with cardiovascular disease approached for participation in the Vanderbilt Inpatient Cohort Study from October 2011 through December 2015, we examined the independent association of patients' health literacy with two steps in their research participation decision-making process: (1) research interest - willingness to hear more about a research study; and (2) research participation - the decision to enroll after an informed consent discussion. Best practices for effective health communication were implemented in recruitment approaches and informed consent processes. Using logistic regression models, we determined patient characteristics independently associated with patients' willingness to hear about and participate in the study. RESULTS In unadjusted analyses, participants with higher health literacy, and those who were younger, female, or had more education had higher levels of both research interest and research participation. Health literacy remained independently associated with both outcomes in multivariable models, after adjustment for sociodemographic factors. CONCLUSION Because identical variables predicted both research interest and eventual consent, efforts to recruit broad populations must include acceptable methods of approaching potential participants as well as explaining study materials.
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Affiliation(s)
- Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN.
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Couey
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Vivian M Yeh
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | | | - John F Schnelle
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
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Oliveira LSD, Costa MFBNAD, Hermida PMV, Andrade SRD, Debetio JO, Lima LMND. Práticas de enfermeiros de um hospital universitário na continuidade do cuidado para a atenção primária. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo compreender as práticas dos enfermeiros de um hospital universitário na continuidade do cuidado para a atenção primária. Método estudo exploratório, descritivo e qualitativo, realizado entre agosto e novembro de 2019, em hospital universitário no Sul do Brasil, com 21 enfermeiros e a diretora de Enfermagem, aplicando-se, respectivamente, um instrumento on-line na plataforma Survey Monkey e uma entrevista semiestruturada. Os dados coletados foram submetidos à Análise de Conteúdo segundo Minayo. Resultados emergiram três categorias: práticas dos enfermeiros; fortalezas e fragilidades e competências para a continuidade do cuidado. Na admissão e alta, os enfermeiros realizam entrevista e exame físico do paciente. Os pontos positivos foram a comunicação e o conhecimento do contexto familiar da equipe multiprofissional hospitalar e os negativos, a falta de sistema informatizado, a integração dos profissionais do hospital com a atenção primária, o enfermeiro gestor de altas e o protocolo de contrarreferência. A continuidade do cuidado requer, dos enfermeiros, experiência profissional, conhecimento sobre a rede de atenção, habilidades de comunicação, liderança e tomada de decisão. Conclusão e implicações para a prática os enfermeiros compreendem a importância da continuidade do cuidado, entretanto, algumas fragilidades encontradas na instituição dificultam a realização dessas práticas.
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Lima MA, Duque AP, Rodrigues Junior LF, Lima VCS, Trotte LAC, Guimaraes TCF. Health literacy and quality of life in hospitalized heart failure patients: a cross-sectional study. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:490-498. [PMID: 33224600 PMCID: PMC7675168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Heart Failure (HF) treatment may be improved by good knowledge of the disease (Health Literacy) that, despite the well-established role on improving self-care, preventing complications and avoiding worse outcomes, has little evidence on affecting QoL of HF patients. Therefore, the objective of the present study was to evaluate the impact of Health Literacy on QoL in hospitalized HF patients. METHODOLOGY A cross-sectional exploratory study was conducted with HF patients hospitalized at a public cardiological hospital. Health Literacy was assessed using the "Questionnaire about Heart Failure Patients' Knowledge of Disease" and QoL using the "Minnesota Living with Heart Failure Questionnaire" (MLHFQ). The association between Health Literacy and QoL was assessed by linear regression (P<0.05). RESULTS 50 patients were included in the study; the mean Health Literacy score was 34.2 ± 15.1 (the majority presenting acceptable or better knowledge). The mean MLHFQ score was 73.5 ± 19.8. The one-year hospital readmission rate (β=+3.8; P=0.009) and the patients' Health Literacy score (β=-0.4; P=0.024) or good knowledge category (β=-20.2; P=0.016) were independently associated with QoL. CONCLUSION While the readmission rate was inversely associated with QoL, the better the HF knowledge the better QoL in hospitalized HF patients.
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Affiliation(s)
- Marcone A Lima
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Alice P Duque
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Luiz F Rodrigues Junior
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
- Department of Physiological Sciences, Federal University of The State of Rio de JaneiroRio de Janeiro-RJ, Brazil
| | - Viviani CS Lima
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Liana AC Trotte
- Department of Nursing Methodology, Federal University of Rio de JaneiroRio de Janeiro-RJ, Brazil
| | - Tereza CF Guimaraes
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
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22
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Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E, Brown TM, Goyal P. Social Determinants of Health and 90-Day Mortality After Hospitalization for Heart Failure in the REGARDS Study. J Am Heart Assoc 2020; 9:e014836. [PMID: 32316807 PMCID: PMC7428585 DOI: 10.1161/jaha.119.014836] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Outcomes following heart failure (HF) hospitalizations are poor, with 90‐day mortality rates of 15% to 20%. Although prior studies found associations between individual social determinants of health (SDOH) and post‐discharge mortality, less is known about how an individuals’ total burden of SDOH affects 90‐day mortality. Methods and Results We included participants of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study who were Medicare beneficiaries aged ≥65 years discharged alive after an adjudicated HF hospitalization. Guided by the Healthy People 2020 Framework, we examined 9 SDOH. First, we examined age‐adjusted associations between each SDOH and 90‐day mortality; those associated with 90‐day mortality were used to create an SDOH count. Next, we determined the hazard of 90‐day mortality by the SDOH count, adjusting for confounders. Over 10 years, 690 participants were hospitalized for HF at 440 unique hospitals in the United States; there were a total of 79 deaths within 90 days. Overall, 28% of participants had 0 SDOH, 39% had 1, and 32% had ≥2. Compared with those with 0, the age‐adjusted hazard ratio for 90‐day mortality among those with 1 SDOH was 2.89 (95% CI, 1.46–5.72) and was 3.06 (1.51–6.19) among those with ≥2 SDOH. The adjusted hazard ratio was 2.78 (1.37–5.62) and 2.57 (1.19–5.54) for participants with 1 SDOH and ≥2, respectively. Conclusions While having any of the SDOH studied here markedly increased risk of 90‐day mortality after an HF hospitalization, a greater burden of SDOH was not associated with significantly greater risk in our population.
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Affiliation(s)
- Madeline R Sterling
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Joanna Bryan Ringel
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Laura C Pinheiro
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Monika M Safford
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Emily B Levitan
- Department of Epidemiology University of Alabama at Birmingham AL
| | - Erica Phillips
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Todd M Brown
- Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL
| | - Parag Goyal
- Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY.,Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
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Liberman JS, Samuels LR, Goggins K, Kripalani S, Roumie CL. Opioid Prescriptions at Hospital Discharge Are Associated With More Postdischarge Healthcare Utilization. J Am Heart Assoc 2020; 8:e010664. [PMID: 30689500 PMCID: PMC6405584 DOI: 10.1161/jaha.118.010664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Many patients use opioids for nonmalignant pain, and opioid use in the general population has been associated with poor long‐term outcomes. The use of high‐risk medications, including opioid analgesics, may increase the risk of unplanned healthcare utilization. Methods and Results We performed a nested evaluation in the VICS (Vanderbilt Inpatient Cohort Study) (N=3000) on patients with an admitting diagnosis of acute coronary syndrome and/or acute decompensated heart failure. Patient enrollment occurred from October 2011 until December 2015 and involved a single investigational site, Vanderbilt University Medical Center (Nashville, TN). Of the 2495 eligible patients, 501 (20%) were discharged with an opioid prescription and were predominantly white and men, with a median age of 59 (interquartile range, 53–67) years. Our primary outcome was unplanned healthcare utilization, which included emergency department presentation or readmission. Secondary outcomes included mortality and a composite of planned utilization behaviors: cardiac rehabilitation and provider follow‐up within 30 days. Cox proportional hazards models did not show a statistically significant association with increased unplanned utilization (adjusted hazard ratio, 1.06; 95% CI, 0.87–1.28) or mortality (adjusted hazard ratio, 1.08; 95% CI, 0.84–1.39), compared with those without opioids at discharge. Patients discharged with opioids were less likely to complete planned healthcare utilization (adjusted odds ratio, 0.69; 95% CI, 0.52–0.91). Conclusions There are decreased odds of planned healthcare utilization among patients with acute coronary syndrome and acute decompensated heart failure discharged with opioid medication. It is imperative to understand how opioid use can affect a patient's relationship with the healthcare system.
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Affiliation(s)
- Justin S Liberman
- 1 Veterans Health Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center Nashville TN.,2 Deparment of Anesthesiology Vanderbilt University Medical Center Nashville TN
| | - Lauren R Samuels
- 1 Veterans Health Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center Nashville TN.,3 Department of Biostatistics Vanderbilt University Medical Center Nashville TN
| | - Kathryn Goggins
- 4 Department of Medicine Vanderbilt University Medical Center Nashville TN.,5 Center for Health Services Research Vanderbilt University Medical Center Nashville TN
| | - Sunil Kripalani
- 3 Department of Biostatistics Vanderbilt University Medical Center Nashville TN.,4 Department of Medicine Vanderbilt University Medical Center Nashville TN.,5 Center for Health Services Research Vanderbilt University Medical Center Nashville TN.,6 Center for Clinical Quality and Implementation Research Vanderbilt University Medical Center Nashville TN
| | - Christianne L Roumie
- 1 Veterans Health Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center Nashville TN.,4 Department of Medicine Vanderbilt University Medical Center Nashville TN.,5 Center for Health Services Research Vanderbilt University Medical Center Nashville TN.,6 Center for Clinical Quality and Implementation Research Vanderbilt University Medical Center Nashville TN
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Norekvål TM, Allore HG, Bendz B, Bjorvatn C, Borregaard B, Brørs G, Deaton C, Fålun N, Hadjistavropoulos H, Hansen TB, Igland S, Larsen AI, Palm P, Pettersen TR, Rasmussen TB, Schjøtt J, Søgaard R, Valaker I, Zwisler AD, Rotevatn S. Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD PCI). BMJ Open 2020; 10:e031995. [PMID: 32054625 PMCID: PMC7045256 DOI: 10.1136/bmjopen-2019-031995] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARDPCI will identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARDPCI is to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI. METHODS AND ANALYSIS This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries. ETHICS AND DISSEMINATION Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations. TRIAL REGISTRATION NUMBER NCT03810612.
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Affiliation(s)
- Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Bjorvatn
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre on Learning and Mastery, Haukeland University Hospital, Bergen, Norway
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Gunhild Brørs
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Christi Deaton
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Stig Igland
- Medical Clinic, Førde Hospital Trust, Førde, Norway
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Pernille Palm
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Jan Schjøtt
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Rikke Søgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Ann Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Ferreira EM, Lourenço OM, Costa PVD, Pinto SC, Gomes C, Oliveira AP, Ferreira Ó, Baixinho CL. Active Life: a project for a safe hospital-community transition after arthroplasty. Rev Bras Enferm 2019; 72:147-153. [DOI: 10.1590/0034-7167-2018-0615] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/26/2018] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To define the criteria for the continuity of care to elderly people submitted to arthroplasty. Method: This is a qualitative study, inserted in the constructivist paradigm, whose methodological option fell on research-action. The participants were the health professionals of an orthopedic service and of the community care teams in the area of the hospital. Results: The different techniques allowed us to identify the difficulties in the safe transition from the hospital to the community. At this level, two categories of criteria for continuity of care emerged: criteria associated with the risk of ineffective management of the therapeutic regimen, and criteria associated with the knowledge and level of competence of the informal caregiver. Final Considerations: An elderly person undergoing arthroplasty (hip or knee) has functional alterations that affect their capacity for self-care and may lead to dependence, our findings allowed the design of an algorithm to facilitate clinical decision making and promote a safe hospital-community transition.
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Wang J, Dietrich MS, Bell SP, Maxwell CA, Simmons SF, Kripalani S. Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study. BMJ Open 2019; 9:e024766. [PMID: 30700484 PMCID: PMC6352778 DOI: 10.1136/bmjopen-2018-024766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES (1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period. DESIGN Secondary analysis of longitudinal data from a cohort study. PARTICIPANTS AND SETTING 834 older (≥65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121). OUTCOME Vulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching. RESULTS Overall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=-1.34(-2.07, -0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%-16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year. CONCLUSION After adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.
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Affiliation(s)
- Jinjiao Wang
- University of Rochester Medical Center, School of Nursing, Rochester, New York, USA
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cathy A Maxwell
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Alves LL, Silva LFD, Cursino EG, Góes FGB, Silva e Sousa ADR, Moraes JRMMD. Preparation of the discharge of relatives of children using antibiotics: contributions of nursing. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2019-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To describe the discharge preparation for relatives of hospitalized children for continuing antibiotic therapy at home, from the nurse perspective. Method: A descriptive and qualitative research, performed in the ward of a pediatric hospital in Rio de Janeiro. It was attended by fifteen nurses through semi-structured interviews, between April and May 2018, and data was submitted to Thematic Analysis. Results: The following thematic units emerged: Preparing the relatives for the discharge as a punctual moment; Professionals involved in the preparation of the discharge for relatives; Educational strategies in preparing the relatives for the discharge; and Communication among professionals in preparing the relatives for the discharge. Conclusion and implications for practice: There is a need to systematize the discharge process of the child that leaves the hospital to finish their therapeutic scheme with antibiotics at home, thereby avoiding inappropriate use and therapeutic errors.
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Mayberry LS, Schildcrout JS, Wallston KA, Goggins K, Mixon AS, Rothman RL, Kripalani S. Health Literacy and 1-Year Mortality: Mechanisms of Association in Adults Hospitalized for Cardiovascular Disease. Mayo Clin Proc 2018; 93:1728-1738. [PMID: 30414733 PMCID: PMC6299453 DOI: 10.1016/j.mayocp.2018.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/03/2018] [Accepted: 07/10/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To test theorized patient-level mediators in the causal pathway between health literacy (HL) and 1-year mortality in adults with cardiovascular disease (CVD). PATIENTS AND METHODS A total of 3000 adults treated at Vanderbilt University Hospital from October 11, 2011, through December 18, 2015, for acute coronary syndrome or acute decompensated heart failure (ADHF) participated in the Vanderbilt Inpatient Cohort Study. Participants completed a bedside-administered survey and consented to health record review and longitudinal follow-up. Multivariable mediation models examined the direct and indirect effects of HL (a latent variable with 4 indicators) with 1-year mortality after discharge (dichotomous). Hypothesized mediators included social support, health competence, health behavior, comorbidity index, type of CVD diagnosis, and previous-year hospitalizations. RESULTS Of the 2977 patients discharged from the hospital (60% male; mean age, 61 years; 83% non-Hispanic white, 37% admitted for ADHF), 17% to 23% had inadequate HL depending on the measure, and 10% (n=304) died within 1 year. The total effect of lower HL on 1-year mortality (adjusted odds ratio [AOR]=1.31; 95% CI, 1.01-1.69) was decomposed into an indirect effect (AOR=1.50; 95% CI, 1.35-1.67) via the mediators and a nonsignificant direct effect (AOR=0.87; 95% CI, 0.66-1.14). Each SD decrease in HL was associated with an absolute 3.2 percentage point increase in the probability of 1-year mortality via mediators admitted for ADHF, comorbidities, health behavior, health competence, and previous-year hospitalizations (listed by contribution to indirect effect). CONCLUSION Patient-level factors link low HL and mortality. Health competence and health behavior are modifiable mediators that could be targeted by interventions post hospitalization for CVD.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN.
| | | | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN; School of Nursing, Vanderbilt University, Nashville, TN
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda S Mixon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Russell L Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
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Donato KM, León-Pérez G, Wallston KA, Kripalani S. Something Old, Something New: When Gender Matters in the Relationship between Social Support and Health. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:352-370. [PMID: 30058378 PMCID: PMC6178235 DOI: 10.1177/0022146518789362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This paper investigates how social support differentially benefits self-rated health among men and women hospitalized with heart disease. Using cross-sectional data about patients admitted to a university hospital, we examine the extent to which gender moderates effects for the frequency of contact with family, friends, and neighbors on health and whether these effects differ between those with new versus established diagnoses. We find that gender differentiates the effect of nonmarital family contact on health but only when heart disease is newly diagnosed. When newly diagnosed, more frequent contact with family is associated with better self-rated health for women but not men. Men and women with preexisting diagnoses benefit equally from more frequent contact with family.
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Affiliation(s)
| | | | - Kenneth A. Wallston
- Center for Effective Health Communication, Vanderbilt University Medical Center
| | - Sunil Kripalani
- Center for Effective Health Communication, Vanderbilt University Medical Center
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Sterling MR, Safford MM, Goggins K, Nwosu SK, Schildcrout JS, Wallston KA, Mixon AS, Rothman RL, Kripalani S. Numeracy, Health Literacy, Cognition, and 30-Day Readmissions among Patients with Heart Failure. J Hosp Med 2018; 13:145-151. [PMID: 29455228 PMCID: PMC5836748 DOI: 10.12788/jhm.2932] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Numeracy, health literacy, and cognition are important for chronic disease management. Prior studies have found them to be associated with poorer selfcare and worse clinical outcomes, but limited data exists in the context of heart failure (HF), a condition that requires patients to monitor their weight, fluid intake, and dietary salt, especially in the posthospitalization period. OBJECTIVE To examine the relationship between numeracy, health literacy, and cognition with 30-day readmissions among patients hospitalized for acute decompensated HF (ADHF). DESIGN, SETTING, PATIENTS The Vanderbilt Inpatient Cohort Study is a prospective longitudinal study of adults hospitalized with acute coronary syndromes and/or ADHF. We studied 883 adults hospitalized with ADHF. MEASUREMENTS During their hospitalization, a baseline interview was performed in which demographic characteristics, numeracy, health literacy, and cognition were assessed. Through chart review, clinical characteristics were determined. The outcome of interest was 30-day readmission to any acute care hospital. To examine the association between numeracy, health literacy, cognition, and 30-day readmissions, multivariable Poisson (log-linear) regression was used. RESULTS Of the 883 patients admitted for ADHF, 23.8% (n = 210) were readmitted within 30 days; 33.9% of the study population had inadequate numeracy skills, 24.6% had inadequate/marginal literacy skills, and 53% had any cognitive impairment. Numeracy and cognition were not associated with 30-day readmissions. Though (objective) health literacy was associated with 30-day readmissions in unadjusted analyses, it was not in adjusted analyses. CONCLUSIONS Numeracy, health literacy, and cognition were not associated with 30-day readmission among this sample of patients hospitalized with ADHF.
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Affiliation(s)
- Madeline R Sterling
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sam K Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Amanda S Mixon
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
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Osborn CY, Kripalani S, Goggins KM, Wallston KA. Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients. J Health Care Poor Underserved 2018; 28:499-513. [PMID: 28239015 DOI: 10.1353/hpu.2017.0036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistants administered surveys to 1,527 patients with acute coronary syndromes or acute decom-pensated heart failure. In adjusted models, having a higher income was associated with being more adherent (p < .001), but was non-significant when adjusted for financial strain. Education, income, less financial strain, and being employed were each associated with better self-rated health (p < .001). Financial strain was associated with less adherence (β =-.17, p < .001) and worse self-rated health (β = -.23, p < .001), and mediated the effect of income on adherence (coeff = .078 [BCa 95% CI: .051 to .108]). Future research should further explore the nuanced link between SES and health behaviors and outcomes.
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Smith RW, Kuluski K, Costa AP, Sinha SK, Glazier RH, Forster A, Jeffs L. Investigating the effect of sociodemographic factors on 30-day hospital readmission among medical patients in Toronto, Canada: a prospective cohort study. BMJ Open 2017; 7:e017956. [PMID: 29237654 PMCID: PMC5728294 DOI: 10.1136/bmjopen-2017-017956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Patients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control. Included in the final analysis was a diverse cohort of 1427 adult, non-palliative, patients who were discharged home. MEASURES Thirteen patient-level sociodemographic variables were examined in relation to time to unplanned all-cause readmission within 30 days. Illness level was accounted for by the following covariates: self-perceived health status, previous hospital utilisation, primary diagnosis case mix group, Charlson Comorbidity Index score and inpatient length of stay. RESULTS Approximately, 14.4% (n=205) of patients experienced readmission within 30 days. Sociodemographic factors were not significantly associated with time to readmission in unadjusted and adjusted analyses. Indicators of illness level, namely, previous hospitalisations, were the strongest risk factors for readmission within this cohort. One previous admission (adjusted HR 1.78; 95% CI 1.22 to 2.59, P<0.01) and at least four previous emergency department visits (adjusted HR 2.33; 95% CI 1.46 to 4.43, P<0.01) were associated with increased hazard of readmission within 30 days. CONCLUSIONS Patient-level sociodemographic factors did not influence the incidence of unplanned all-cause readmission within 30 days. Further research is needed to understand the generalisability of our findings and investigate whether contextual factors, such as access to universal health insurance coverage, attenuate the effects of sociodemographic factors.
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Affiliation(s)
- Robert W Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Alan Forster
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Holden RJ, Kulanthaivel A, Purkayastha S, Goggins KM, Kripalani S. Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure. Int J Med Inform 2017; 108:158-167. [PMID: 29132622 PMCID: PMC5793874 DOI: 10.1016/j.ijmedinf.2017.10.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Personas are a canonical user-centered design method increasingly used in health informatics research. Personas-empirically-derived user archetypes-can be used by eHealth designers to gain a robust understanding of their target end users such as patients. OBJECTIVE To develop biopsychosocial personas of older patients with heart failure using quantitative analysis of survey data. METHOD Data were collected using standardized surveys and medical record abstraction from 32 older adults with heart failure recently hospitalized for acute heart failure exacerbation. Hierarchical cluster analysis was performed on a final dataset of n=30. Nonparametric analyses were used to identify differences between clusters on 30 clustering variables and seven outcome variables. RESULTS Six clusters were produced, ranging in size from two to eight patients per cluster. Clusters differed significantly on these biopsychosocial domains and subdomains: demographics (age, sex); medical status (comorbid diabetes); functional status (exhaustion, household work ability, hygiene care ability, physical ability); psychological status (depression, health literacy, numeracy); technology (Internet availability); healthcare system (visit by home healthcare, trust in providers); social context (informal caregiver support, cohabitation, marital status); and economic context (employment status). Tabular and narrative persona descriptions provide an easy reference guide for informatics designers. DISCUSSION Personas development using approaches such as clustering of structured survey data is an important tool for health informatics professionals. We describe insights from our study of patients with heart failure, then recommend a generic ten-step personas development process. Methods strengths and limitations of the study and of personas development generally are discussed.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | - Anand Kulanthaivel
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Kathryn M Goggins
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Heerman WJ, Jackson N, Hargreaves M, Mulvaney SA, Schlundt D, Wallston KA, Rothman RL. Clusters of Healthy and Unhealthy Eating Behaviors Are Associated With Body Mass Index Among Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:415-421.e1. [PMID: 28363804 PMCID: PMC5747265 DOI: 10.1016/j.jneb.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify eating styles from 6 eating behaviors and test their association with body mass index (BMI) among adults. DESIGN Cross-sectional analysis of self-report survey data. SETTING Twelve primary care and specialty clinics in 5 states. PARTICIPANTS Of 11,776 adult patients who consented to participate, 9,977 completed survey questions. VARIABLES MEASURED Frequency of eating healthy food, frequency of eating unhealthy food, breakfast frequency, frequency of snacking, overall diet quality, and problem eating behaviors. The primary dependent variable was BMI, calculated from self-reported height and weight data. ANALYSIS k-Means cluster analysis of eating behaviors was used to determine eating styles. A categorical variable representing each eating style cluster was entered in a multivariate linear regression predicting BMI, controlling for covariates. RESULTS Four eating styles were identified and defined by healthy vs unhealthy diet patterns and engagement in problem eating behaviors. Each group had significantly higher average BMI than the healthy eating style: healthy with problem eating behaviors (β = 1.9; P < .001), unhealthy (β = 2.5; P < .001), and unhealthy with problem eating behaviors (β = 5.1; P < .001). CONCLUSIONS AND IMPLICATIONS Future attempts to improve eating styles should address not only the consumption of healthy foods but also snacking behaviors and the emotional component of eating.
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Affiliation(s)
- William J Heerman
- General Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN.
| | - Natalie Jackson
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN
| | | | - Shelagh A Mulvaney
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; School of Nursing, Vanderbilt University, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - David Schlundt
- Center for Health Services Research, Vanderbilt University, Nashville, TN
| | | | - Russell L Rothman
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN
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Abstract
BACKGROUND Low health literacy affects millions of Americans, putting those who are affected at a disadvantage and at risk for poorer health outcomes. Low health literacy can act as a barrier to effective disease self-management; this is especially true for chronic diseases such as heart failure (HF) that require complicated self-care regimens. PURPOSE This systematic review examined quantitative research literature published between 1999 and 2014 to explore the role of health literacy among HF patients. The specific aims of the systematic review are to (1) describe the prevalence of low health literacy among HF patients, (2) explore the predictors of low health literacy among HF patients, and (3) discuss the relationship between health literacy and HF self-care and common HF outcomes. METHODS A systematic search of the following databases was conducted, PubMed, CINAHL Plus, Embase, PsycINFO, and Scopus, using relevant keywords and clear inclusion and exclusion criteria. CONCLUSIONS An average of 39% of HF patients have low health literacy. Age, race/ethnicity, years of education, and cognitive function are predictors of health literacy. In addition, adequate health literacy is consistently correlated with higher HF knowledge and higher salt knowledge. CLINICAL IMPLICATIONS Considering the prevalence of low health literacy among in the HF population, nurses and healthcare professionals need to recognize the consequences of low health literacy and adopt strategies that could minimize its detrimental effect on the patient's health outcomes.
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Affiliation(s)
- Amanda S Mixon
- Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Sunil Kripalani
- Vanderbilt University School of Medicine, Nashville, TN, USA
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Srinivas P, Cornet V, Holden R. Human factors analysis, design, and evaluation of Engage, a consumer health IT application for geriatric heart failure self-care. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2016; 33:298-312. [PMID: 30429638 PMCID: PMC6231419 DOI: 10.1080/10447318.2016.1265784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Human factors and ergonomics (HFE) and related approaches can be used to enhance research and development of consumer-facing health IT systems, including technologies supporting the needs of people with chronic disease. We describe a multiphase HFE study of health IT supporting self-care of chronic heart failure by older adults. The study was based on HFE frameworks of "patient work" and incorporated the three broad phases of user-centered design: study or analysis; design; and evaluation. In the study phase, data from observations, interviews, surveys, and other methods were analyzed to identify gaps in and requirements for supporting heart failure self-care. The design phase applied findings from the study phase throughout an iterative process, culminating in the design of the Engage application, a product intended for continuous use over 30 days to stimulate self-care engagement, behavior, and knowledge. During the evaluation phase, we identified a variety of usability issues through expert heuristic evaluation and laboratory-based usability testing. We discuss the implications of our findings regarding heart failure self-care in older adults and the methodological challenges of rapid translational field research and development in this domain.
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Affiliation(s)
- Preethi Srinivas
- Indiana University Center for Aging Research (IUCAR),
Regenstrief Institute, Inc. – Indianapolis, IN, USA
| | - Victor Cornet
- Indiana University School of Informatics and Computing
– Indianapolis, IN, USA
| | - Richard Holden
- Indiana University Center for Aging Research (IUCAR),
Regenstrief Institute, Inc. – Indianapolis, IN, USA
- Indiana University School of Informatics and Computing
– Indianapolis, IN, USA
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Bachmann JM, Goggins KM, Nwosu SK, Schildcrout JS, Kripalani S, Wallston KA. Perceived health competence predicts health behavior and health-related quality of life in patients with cardiovascular disease. PATIENT EDUCATION AND COUNSELING 2016; 99:2071-2079. [PMID: 27450479 PMCID: PMC5525151 DOI: 10.1016/j.pec.2016.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Evaluate the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life. METHODS We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United States. Multivariable linear regression models investigated associations between the two-item perceived health competence scale (PHCS-2) and positive health behaviors such as medication adherence and exercise (Health Behavior Index) as well as health-related quality of life (5-item Patient Reported Outcome Information Measurement System Global Health Scale). RESULTS After multivariable adjustment, perceived health competence was highly associated with health behaviors (p<0.001) and health-related quality of life (p<0.001). Low perceived health competence was associated with a decrease in health-related quality of life between hospitalization and 90days after discharge (p<0.001). CONCLUSIONS Perceived health competence predicts health behavior and health-related quality of life in patients hospitalized with cardiovascular disease as well as change in health-related quality of life after discharge. PRACTICE IMPLICATIONS Patients with low perceived health competence may be at risk for a decline in health-related quality of life after hospitalization and thus a potential target for counseling and other behavioral interventions.
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Affiliation(s)
- Justin M Bachmann
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
| | - Kathryn M Goggins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
| | - Samuel K Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA.
| | | | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
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Acosta A, Lima M, Marques G, Levandovski P, Weber L. Brazilian version of the Care Transitions Measure: translation and validation. Int Nurs Rev 2016; 64:379-387. [DOI: 10.1111/inr.12326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A.M. Acosta
- School of Nursing; Federal University of Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - M.A.D.S. Lima
- School of Nursing; Federal University of Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - G.Q. Marques
- School of Nursing; Federal University of Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - P.F. Levandovski
- School of Nursing; Federal University of Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - L.A.F. Weber
- School of Nursing; Federal University of Rio Grande do Sul (UFRGS); Porto Alegre Brazil
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Goggins K, Wallston KA, Mion L, Cawthon C, Kripalani S. What Patient Characteristics Influence Nurses' Assessment of Health Literacy? JOURNAL OF HEALTH COMMUNICATION 2016; 21:105-108. [PMID: 27668543 PMCID: PMC5078982 DOI: 10.1080/10810730.2016.1193919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Overestimation of patients' health literacy skills is common among nurses and physicians. At Vanderbilt University Hospital, nurses routinely ask patients the 3 Brief Health Literacy Screen (BHLS) questions. Data from 2 studies that recruited patients at Vanderbilt University Hospital-the Health Literacy Screening (HEALS) study and the Vanderbilt Inpatient Cohort Study (VICS)-were analyzed to compare the BHLS score recorded by nurses during clinical care with the score recorded by trained research assistants during the same hospitalization. Logistic regression models determined which patient characteristics were associated with nurses documenting higher health literacy scores than research assistants. Overall, the majority (60%) of health literacy scores were accurate, though nurses recorded meaningfully higher health literacy scores in 28.4% of HEALS patients and 35.6% of VICS patients. In the HEALS cohort, patients who were male and had less education were more likely to have higher health literacy scores recorded by nurses (odds ratio [OR] = 1.93, 95% confidence interval [CI] [1.24, 3.00]; and OR = 0.80, 95% CI [0.74, 0.88], respectively). In the VICS cohort, patients who were older, were male, and had less education were more likely to have higher health literacy scores recorded by nurses (OR = 1.01, 95% CI [1.003, 1.02]; OR = 1.49, 95% CI [1.20, 1.84]; and OR = 0.87, 95% CI [0.83, 0.90], respectively). These findings suggest that health literacy scores recorded by nurses for male patients and patients with less education could be overestimated. Thus, health care professionals should be aware of this tendency and should verify the results of routine health literacy screening tests, especially in certain patient groups.
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Affiliation(s)
- Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Kenneth. A. Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN
| | - Lorraine Mion
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN
| | - Courtney Cawthon
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Mixon AS, Goggins K, Bell SP, Vasilevskis EE, Nwosu S, Schildcrout JS, Kripalani S. Preparedness for hospital discharge and prediction of readmission. J Hosp Med 2016; 11:603-9. [PMID: 26929109 PMCID: PMC5003753 DOI: 10.1002/jhm.2572] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/26/2016] [Accepted: 02/02/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND, OBJECTIVE Patients' self-reported preparedness for discharge has been shown to predict readmission. It is unclear what differences exist in the predictive abilities of 2 available discharge preparedness measures. To address this gap, we conducted a comparison of these measures. DESIGN, SETTING, PATIENTS Adults hospitalized for cardiovascular diagnoses were enrolled in a prospective cohort. MEASUREMENTS Two patient-reported preparedness measures assessed during postdischarge calls: the 11-item Brief Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services (B-PREPARED) and the 3-item Care Transitions Measure (CTM-3). Cox proportional hazard models analyzed the relationship between preparedness and time to first readmission or death at 30 and 90 days, adjusted for readmission risk using the administrative database-derived Length of stay, Acuity, Comorbidity, and Emergency department use (LACE) index and other covariates. RESULTS Median preparedness scores were: B-PREPARED 21 (interquartile range [IQR] 18-22) and CTM-3 77.8 (IQR 66.7-100). In individual Cox models, a 4-point increase in B-PREPARED score was associated with a 16% decrease in time to readmission or death at 30 and 90 days. A 10-point increase in CTM-3 score was not associated with readmission or death at 30 days, but was associated with a 6% decrease in readmission or death at 90 days. In models with both preparedness scores, B-PREPARED retained an association with readmission or death at both 30 and 90 days. However, neither preparedness score was as strong a predictor as the LACE index when all were included in the model predicting 30- and 90-day readmission or death. CONCLUSION The B-PREPARED score was more strongly associated with readmission or death than the more widely adopted CTM-3, but neither predicted readmission as well as the LACE index. Journal of Hospital Medicine 2016;11:603-609. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Amanda S. Mixon
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), 1310 24 avenue South, Nashville, TN 37212-2637
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, D-3100, Medical Center North, Nashville, TN 37232-2358
- Center for Health Services Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
| | - Susan P. Bell
- Center for Quality Aging, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 350, Nashville, TN, 37203-1425
| | - Eduard E. Vasilevskis
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), 1310 24 avenue South, Nashville, TN 37212-2637
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, D-3100, Medical Center North, Nashville, TN 37232-2358
- Center for Health Services Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
- Center for Quality Aging, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 350, Nashville, TN, 37203-1425
| | - Samuel Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Ste. 11000 Nashville, TN 37203
| | - Jonathan S. Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Ste. 11000 Nashville, TN 37203
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, D-3100, Medical Center North, Nashville, TN 37232-2358
- Center for Health Services Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Medical Center East, Suite 6000, Nashville, Tennessee 37232-8300
- Center for Quality Aging, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 350, Nashville, TN, 37203-1425
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Matsuoka S, Tsuchihashi-Makaya M, Kayane T, Yamada M, Wakabayashi R, Kato NP, Yazawa M. Health literacy is independently associated with self-care behavior in patients with heart failure. PATIENT EDUCATION AND COUNSELING 2016; 99:1026-1032. [PMID: 26830514 DOI: 10.1016/j.pec.2016.01.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL have focused predominantly on the relationships between functional HL (the ability to read and write), comprehensive HL including the ability to access information (communicative HL), and the ability to critically evaluate information (critical HL). Self-care behavior has not been evaluated. This study determined the relationship between functional, communicative, and critical HL and self-care behavior in HF patients. METHODS Cross-sectional analysis of the data was completed for HL, HF-related knowledge, and HF-related self-care behaviors. Sociodemographic and clinical characteristics were also assessed. Multivariate linear regression analysis was used to estimate the associations between literacy and self-care behavior. RESULTS 249 patients with HF were assessed (mean age, 67.7±13.9years). Patients with low HL had poorer knowledge and self-care behavior than those with high HL. Critical HL was an independent determinant of self-care behavior (sβ=-0.154, P=0.027). CONCLUSIONS Critical HL was independently associated with self-care behavior in HF patients. PRACTICE IMPLICATIONS Effective intervention should be developed to improve patient skills for critically analyzing information and making decisions.
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Affiliation(s)
- Shiho Matsuoka
- Section of Liaison Psychiatry & Palliative Medicine, Graduate School of Medical & Dental Sciences, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Miyuki Tsuchihashi-Makaya
- School of Nursing, Kitasato University, 2-1-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan.
| | - Takahiro Kayane
- Department of Nursing, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo 133-0052, Japan.
| | - Michiyo Yamada
- Department of Nursing, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo 133-0052, Japan.
| | - Rumi Wakabayashi
- Department of Nursing, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan.
| | - Naoko P Kato
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden.
| | - Miyuki Yazawa
- Department of Cardiology, Saiseikai Karatsu Hospital, 817 Motohatamachi, Karatsu-shi, Saga 847-0852, Japan.
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Kim CJ, Park E, Schlenk EA, Kim M, Kim DJ. Psychometric Evaluation of a Korean Version of the Adherence to Refills and Medications Scale (ARMS) in Adults With Type 2 Diabetes. DIABETES EDUCATOR 2016; 42:188-98. [PMID: 26902527 DOI: 10.1177/0145721716632062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to examine the reliability and validity of the Adherence to Refills and Medications Scale-Korean (ARMS-K) among Korean adults with type 2 diabetes. METHODS The Korean translated ARMS-K was back-translated to ensure translation equivalency. A cross-sectional survey was used to evaluate the psychometric properties with exploratory factor analysis for validity and Cronbach's alpha coefficients for reliability. RESULTS The factor analysis of construct validity identified 3 dimensions of the ARMS-K, explaining 54.7% of the total variance. The internal consistency reliability for the total instrument was acceptable with a Cronbach's alpha of .801. There was good correlation between the ARMS-K and 8-item Morisky Medication Adherence Scale-Korean version (r = -0.698), indicating that these scales measure theoretically related constructs as evidence of convergent validity. As evidence of known groups validity, there was a significant association between the ARMS-K score and glycemic control (P = .048), indicating that the good glycemic controlled group was more likely to have a higher rate of adherence to refills and medications than the poor glycemic controlled group. CONCLUSIONS These results support the cross-cultural applicability of the concepts underlying the ARMS-K. The ARMS-K can be used not only to assess adherence to refills and medications in Koreans with diabetes but also to examine the potential role of adherence to refills and medications in enhanced glycemic control of people with diabetes in a variety of clinical settings.
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Affiliation(s)
- Chun-Ja Kim
- Ajou University College of Nursing Institution of Nursing Science, Korea (Dr Kim)
| | - Eunyoung Park
- Department of Nursing Science, Sangji University, Korea (Dr Park)
| | - Elizabeth A Schlenk
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Schlenk)
| | - Moonsun Kim
- Ajou University College of Nursing, Korea (Ms Kim)
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Korea (Dr Kim)
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Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization. J Behav Med 2015; 39:441-52. [PMID: 26660867 DOI: 10.1007/s10865-015-9702-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/25/2015] [Indexed: 12/23/2022]
Abstract
Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.
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Bell SP, Schnelle J, Nwosu SK, Schildcrout J, Goggins K, Cawthon C, Mixon AS, Vasilevskis EE, Kripalani S. Development of a multivariable model to predict vulnerability in older American patients hospitalised with cardiovascular disease. BMJ Open 2015; 5:e008122. [PMID: 26316650 PMCID: PMC4554894 DOI: 10.1136/bmjopen-2015-008122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To identify vulnerable cardiovascular patients in the hospital using a self-reported function-based screening tool. PARTICIPANTS Prospective observational cohort study of 445 individuals aged ≥ 65 years admitted to a university medical centre hospital within the USA with acute coronary syndrome and/or decompensated heart failure. METHODS Participants completed an inperson interview during hospitalisation, which included vulnerable functional status using the Vulnerable Elders Survey (VES-13), sociodemographic, healthcare utilisation practices and clinical patient-specific measures. A multivariable proportional odds logistic regression model examined associations between VES-13 and prior healthcare utilisation, as well as other coincident medical and psychosocial risk factors for poor outcomes in cardiovascular disease. RESULTS Vulnerability was highly prevalent (54%) and associated with a higher number of clinic visits, emergency room visits and hospitalisations (all p<0.001). A multivariable analysis demonstrating a 1-point increase in VES-13 (vulnerability) was independently associated with being female (OR 1.55, p=0.030), diagnosis of heart failure (OR 3.11, p<0.001), prior hospitalisations (OR 1.30, p<0.001), low social support (OR 1.42, p=0.007) and depression (p<0.001). A lower VES-13 score (lower vulnerability) was associated with increased health literacy (OR 0.70, p=0.002). CONCLUSIONS Vulnerability to functional decline is highly prevalent in hospitalised older cardiovascular patients and was associated with patient risk factors for adverse outcomes and an increased use of healthcare services.
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Affiliation(s)
- Susan P Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee, USA
| | - John Schnelle
- Division of General Internal Medicine and Public Health, Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee, USA
| | - Samuel K Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA
| | - Courtney Cawthon
- Center for Health Services Research, Vanderbilt University, Nashville, Tennessee, USA
| | - Amanda S Mixon
- Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare System—Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Eduard E Vasilevskis
- Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare System—Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee, USA
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Potentials of internet-based patient engagement and education programs to reduce hospital readmissions: a spotlight on need in heart failure. Nurs Clin North Am 2015; 50:283-91. [PMID: 25999071 DOI: 10.1016/j.cnur.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Internet-based applications and mobile health technology has advanced at unprecedented rates over the last decade and has proved to be a highly effective platform for communication. Simultaneously, the United States health care system has reached a critical and unsustainable level of spending, arising largely from ingrained system inefficiencies and overall suboptimum communication. Internet-based and mobile health technology offers an innovative solution to both of these problems. The prevention of readmissions for heart failure provides an excellent example of how this new technology can be used in today's health care environment to improve patient care.
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47
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McNaughton CD, Cavanaugh KL, Kripalani S, Rothman RL, Wallston KA. Validation of a Short, 3-Item Version of the Subjective Numeracy Scale. Med Decis Making 2015; 35:932-6. [PMID: 25878195 DOI: 10.1177/0272989x15581800] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Efficiency in scale design reduces respondent burden. A brief but reliable measure of numeracy may provide a useful research tool eligible for integration into large epidemiological studies or clinical trials. Our goal was to validate a 3-item version of the Subjective Numeracy Scale (SNS-3). DESIGN AND SETTING We examined 7 separate cross-sectional data sets: patients in the emergency department (n = 208), clinic (n = 205), and hospital (n = 460; n = 2053) and patients with chronic kidney disease (n = 147), with diabetes (n = 318), and on hemodialysis (n = 143). MEASUREMENTS Internal reliability of the SNS-3 was assessed with Cronbach's α. Criterion validity was determined by nonparametric correlations of the SNS-3 with SNS-8 and other measures of numeracy; construct validity was determined by correlations with measures of health literacy and education. RESULTS The SNS-3 had good internal reliability (median Cronbach's α = 0.78) and correlated highly with the full SNS (median ρ = 0.91). The SNS-3 was significantly correlated with other measures of numeracy (e.g., median ρ = 0.57 with the Wide Range Achievement Test 4), health literacy (e.g., median ρ = 0.35 with the Shortened Test of Functional Health Literacy in Adults), and education (median ρ = 0.41), providing good evidence of criterion and construct validity. CONCLUSION The SNS-3 is sufficiently reliable and valid to be used as a measure of subjective numeracy.
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Affiliation(s)
- Candace D McNaughton
- Department of Emergency Medicine (CDM), Vanderbilt University, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Department of Internal Medicine (KLC, SK, RLR), Vanderbilt University, Nashville, TN, USA,Vanderbilt Center for Kidney Disease (KLC), Vanderbilt University, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Internal Medicine (KLC, SK, RLR), Vanderbilt University, Nashville, TN, USA
| | - Russell L Rothman
- Department of Internal Medicine (KLC, SK, RLR), Vanderbilt University, Nashville, TN, USA
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48
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Leak C, Goggins K, Schildcrout JS, Theobald C, Donato KM, Bell SP, Schnelle J, Kripalani S. Effect of Health Literacy on Research Follow-Up. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:83-91. [PMID: 26513035 PMCID: PMC4706551 DOI: 10.1080/10810730.2015.1058442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence, and health care system distrust. In a sample of 2,042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days, and 90 days after hospital discharge. In addition, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up.
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Affiliation(s)
- Cardella Leak
- Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center
- Center for Effective Health Communication, Vanderbilt University Medical Center
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center
| | - Jonathan S. Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center
- Department of Anesthesiology, Vanderbilt University Medical Center
| | - Cecelia Theobald
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
| | | | - Susan P. Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
| | - John Schnelle
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center
- Center for Effective Health Communication, Vanderbilt University Medical Center
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
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49
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Kripalani S, Goggins K, Nwosu S, Schildcrout J, Mixon AS, McNaughton C, McDougald Scott AM, Wallston KA. Medication Nonadherence Before Hospitalization for Acute Cardiac Events. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:34-42. [PMID: 26513029 PMCID: PMC4705844 DOI: 10.1080/10810730.2015.1080331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were admitted for acute coronary syndrome or heart failure completed validated assessments of self-reported medication adherence (the Adherence to Refills and Medications Scale), demographic characteristics, health literacy, numeracy, social support, depressive symptoms, and health competence. We modeled the independent predictors of nonadherence before hospitalization, standardizing estimated effects by each predictor's interquartile range. Among 1,967 patients studied, 70.7% indicated at least some degree of medication nonadherence leading up to their hospitalization. Adherence was significantly lower among patients with lower health literacy (0.18-point change in adherence score per interquartile range change in health literacy), lower numeracy (0.28), lower health competence (0.30), and more depressive symptoms (0.52) and those of younger age, of non-White race, of male gender, or with less social support. Medication nonadherence in the period before hospitalization is more prevalent among patients with lower health literacy, numeracy, or other intervenable psychosocial factors. Addressing these factors in a coordinated care model may reduce hospitalization rates.
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Affiliation(s)
- Sunil Kripalani
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kathryn Goggins
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Sam Nwosu
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Jonathan Schildcrout
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda S Mixon
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- e Department of Veterans Affairs , Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA
| | - Candace McNaughton
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda M McDougald Scott
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- g Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kenneth A Wallston
- h School of Nursing , Vanderbilt University Medical Center , Nashville , Tennessee , USA
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50
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Dodson JA, Geda M, Krumholz HM, Lorenze N, Murphy TE, Allore HG, Charpentier P, Tsang SW, Acampora D, Tinetti ME, Gill TM, Chaudhry SI. Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study. BMC Health Serv Res 2014; 14:506. [PMID: 25370536 PMCID: PMC4239317 DOI: 10.1186/s12913-014-0506-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/09/2014] [Indexed: 01/28/2023] Open
Abstract
Background While older adults (age 75 and over) represent a large and growing proportion of patients with acute myocardial infarction (AMI), they have traditionally been under-represented in cardiovascular studies. Although chronological age confers an increased risk for adverse outcomes, our current understanding of the heterogeneity of this risk is limited. The Comprehensive Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI) study was designed to address this gap in knowledge by evaluating risk factors (including geriatric impairments, such as muscle weakness and cognitive impairments) for hospital readmission, mortality, and health status decline among older adults hospitalized for AMI. Methods/Design SILVER-AMI is a prospective cohort study that is enrolling 3000 older adults hospitalized for AMI from a recruitment network of approximately 70 community and academic hospitals across the United States. Participants undergo a comprehensive in-hospital assessment that includes clinical characteristics, geriatric impairments, and health status measures. Detailed medical record abstraction complements the assessment with diagnostic study results, in-hospital procedures, and medications. Participants are subsequently followed for six months to determine hospital readmission, mortality, and health status decline. Multivariable regression will be used to develop risk models for these three outcomes. Discussion SILVER-AMI will fill critical gaps in our understanding of AMI in older patients. By incorporating geriatric impairments into our understanding of post-AMI outcomes, we aim to create a more personalized assessment of risk and identify potential targets for interventions. Trial registration Trial registration number: NCT01755052.
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Affiliation(s)
- John A Dodson
- Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Mary Geda
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. .,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. .,Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA. .,Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA.
| | - Nancy Lorenze
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Terrence E Murphy
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Peter Charpentier
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Sui W Tsang
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Denise Acampora
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Mary E Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Thomas M Gill
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Yale University School of Medicine, Harkness Office Building, Room 411, New Haven, CT, 06520, USA.
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