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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. [PMID: 38560772 DOI: 10.1002/jhm.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo Trochez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sam Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, 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
| | - Sarah A Welch
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M Bachmann
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kerri L Cavanaugh
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russell L Rothman
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil B Kripalani
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, VUMC, Nashville, Tennessee, 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 post-discharge mortality after cardiac hospitalization. medRxiv 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] [What about the content of this article? (0)] [Abstract] [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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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: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Chakravarthy R, Goggins K, Leverenz D, Trumbo SP, Kripalani S, Limper HM. Lessons Learned from Efforts to Reduce Overuse of Cardiac Telemetry Monitoring. Jt Comm J Qual Patient Saf 2020; 46:464-470. [PMID: 32505628 DOI: 10.1016/j.jcjq.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Inappropriate use of telemetry monitoring is common, increasing costs, false alarms, and length of stay. The Society of Hospital Medicine and Choosing Wisely encourage the use of discontinuation protocols. METHODS This quality improvement initiative measured the impact of an educational intervention and distribution of performance reports for physicians and residents on the general medicine service. The intervention group received a 15-minute didactic session on appropriate indications for telemetry followed by weekly performance reports for 78 weeks. A segmented linear regression model and Student's t-test were used to determine intervention effects on percentage of patients on telemetry and telemetry orders lasting more than 48 hours. RESULTS Prior to the intervention, 4.8% of patients received telemetry monitoring; 13.4% of telemetry orders exceeded 48 hours. The control service had a baseline telemetry utilization of 2.4%; 1.2% of telemetry orders exceeded 48 hours. After the intervention, 3.9% of patients received telemetry monitoring; 10.6% of telemetry orders exceeded 48 hours. The control service had a postintervention telemetry utilization of 2.1%; 1.1% of telemetry orders exceeded 48 hours. The Student's t-test showed a statistically significant (p = 0.002) decrease in telemetry ordering rate on the intervention service and no significant change in the control group. However, when using segmented linear regression analysis, these changes could not be attributed to the intervention nor were there any significant changes in balancing metrics. CONCLUSION Education and weekly performance feedback did not significantly impact telemetry according to segmented linear regression results. Segmented linear regression analysis of an interrupted time series yielded significantly different results from a pre-post comparison using Student's t-test. Rigorous evaluation is vital to decreasing unnecessary care and successful reduction in unnecessary care may require interventions that capitalize on systems-level change.
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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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6
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Chadefaux D, Goggins K, Cazzaniga C, Marzaroli P, Marelli S, Katz R, Eger T, Tarabini M. Development of a two-dimensional dynamic model of the foot-ankle system exposed to vibration. J Biomech 2020; 99:109547. [DOI: 10.1016/j.jbiomech.2019.109547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
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Cronin RM, Jerome RN, Mapes B, Andrade R, Johnston R, Ayala J, Schlundt D, Bonnet K, Kripalani S, Goggins K, Wallston KA, Couper MP, Ellitt MR, Harris P, Begale M, Munoz F, Lopez-Class M, Cella D, Condon D, AuYoung M, Mazor KM, Mikita S, Manganiello M, Borselli N, Fowler S, Rutter JL, Denny JC, Karlson EW, Ahmedani BK, O’Donnell C. Development of the Initial Surveys for the All of Us Research Program. Epidemiology 2019; 30:597-608. [PMID: 31045611 PMCID: PMC6548672 DOI: 10.1097/ede.0000000000001028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The All of Us Research Program is building a national longitudinal cohort and collecting data from multiple information sources (e.g., biospecimens, electronic health records, and mobile/wearable technologies) to advance precision medicine. Participant-provided information, collected via surveys, will complement and augment these information sources. We report the process used to develop and refine the initial three surveys for this program. METHODS The All of Us survey development process included: (1) prioritization of domains for scientific needs, (2) examination of existing validated instruments, (3) content creation, (4) evaluation and refinement via cognitive interviews and online testing, (5) content review by key stakeholders, and (6) launch in the All of Us electronic participant portal. All content was translated into Spanish. RESULTS We conducted cognitive interviews in English and Spanish with 169 participants, and 573 individuals completed online testing. Feedback led to over 40 item content changes. Lessons learned included: (1) validated survey instruments performed well in diverse populations reflective of All of Us; (2) parallel evaluation of multiple languages can ensure optimal survey deployment; (3) recruitment challenges in diverse populations required multiple strategies; and (4) key stakeholders improved integration of surveys into larger Program context. CONCLUSIONS This efficient, iterative process led to successful testing, refinement, and launch of three All of Us surveys. Reuse of All of Us surveys, available at http://researchallofus.org, may facilitate large consortia targeting diverse populations in English and Spanish to capture participant-provided information to supplement other data, such as genetic, physical measurements, or data from electronic health records.
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Affiliation(s)
- Robert M. Cronin
- Department of Biomedical Informatics and Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca N. Jerome
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandy Mapes
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Regina Andrade
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Johnston
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Ayala
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth A. Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mick P. Couper
- Survey Research Center, University of Michigan. Ann Arbor, MI, USA
- Joint Program in Survey Methodology, University of Maryland, College Park, MD, USA
| | - Michael R. Ellitt
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Paul Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fatima Munoz
- Department of Research and Health Promotion, San Ysidro Health, San Diego, California, USA
| | - Maria Lopez-Class
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Condon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California, United States
| | | | - Steve Mikita
- Spinal Muscular Atrophy Foundation, New York, New York, United States of America
| | | | | | - Stephanie Fowler
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - Joni L. Rutter
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - Joshua C. Denny
- Department of Biomedical Informatics and Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth W. Karlson
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Section of Clinical Sciences, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian K. Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Chris O’Donnell
- Cardiology Section, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wray R, Weaver N, Adsul P, Gautam K, Jupka K, Zellin S, Goggins K, Vijaykumar S, Hansen N, Rudd R. Enhancing organizational health literacy in a rural Missouri clinic: a qualitative case study. Int J Health Care Qual Assur 2019; 32:788-804. [PMID: 31195931 DOI: 10.1108/ijhcqa-05-2018-0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy. DESIGN/METHODOLOGY/APPROACH The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change. FINDINGS Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible. ORIGINALITY/VALUE The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy.
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Affiliation(s)
- Ricardo Wray
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Nancy Weaver
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Prajakta Adsul
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, USA
| | - Kanak Gautam
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Keri Jupka
- Parents as Teachers, St Louis, Missouri, USA
| | - Stacie Zellin
- National Council on Alcoholism & Drug Abuse, St Louis, Missouri, USA
| | | | | | - Natasha Hansen
- College for Public Health and Social Justice, Saint Louis University , St Louis, Missouri, USA
| | - Rima Rudd
- Harvard School of Public Health, Boston, Massachusetts, USA
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Kripalani S, Heerman WJ, Patel NJ, Jackson N, Goggins K, Rothman RL, Yeh VM, Wallston KA, Smoot DT, Wilkins CH. Association of Health Literacy and Numeracy with Interest in Research Participation. J Gen Intern Med 2019; 34:544-551. [PMID: 30684202 PMCID: PMC6445877 DOI: 10.1007/s11606-018-4766-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is much attention to recruitment of diverse populations in research, but little is known about the influence of health literacy and numeracy skills. OBJECTIVE To determine if health literacy and numeracy affect individuals' interest to participate in research studies. DESIGN Cross-sectional survey data were pooled from 3 large studies conducted in the Mid-South Clinical Data Research Network. PARTICIPANTS Adult patients enrolled in 1 of 3 Mid-South Clinical Data Research Network studies. MAIN MEASURES The survey domains included demographic items, the 3-item Brief Health Literacy Screen (range 3-15), and the 3-item Subjective Numeracy Scale (range 3-18). The outcome was a sum index measure of a 7-item instrument (range 7-21) assessing individuals' interest in participating in different types of research, including research that involves taking surveys, giving a blood sample, participating via phone or internet, taking an investigational medication, meeting at a local community center or school, including family, or staying overnight at a hospital. KEY RESULTS Respondents (N = 15,973) were predominately women (65.5%), White (81.4%), and middle aged (M = 52.8 years, SD = 16.5); 32.4% previously participated in research. Self-reported health literacy was relatively high (M = 13.5 out of 15, SD = 2.1), and subjective numeracy skills were somewhat lower (M = 14.3 out of 18, SD = 3.6). After adjustment for age, gender, race, income, education, and other characteristics, lower health literacy and numeracy skills were each independently associated with less interest in research participation (p < 0.001 for each). Prior research participation was associated with greater interest in future research participation (p < 0.001). CONCLUSIONS After adjustment for factors known to be predictive of interest, individuals with lower health literacy or numeracy scores were less interested in participating in research. Additional work is needed to elucidate reasons for this finding and to determine strategies to engage these populations.
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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, USA.
- 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.
| | - William J Heerman
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Niral J Patel
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natalie Jackson
- Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Kathryn 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
| | - Russell L Rothman
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- 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
| | - Vivian M Yeh
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Duane T Smoot
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Trumbo SP, Iams WT, Limper HM, Goggins K, Gibson J, Oliver L, Leverenz DL, Samuels LR, Brady DW, Kripalani S. Deimplementation of Routine Chest X-rays in Adult Intensive Care Units. J Hosp Med 2019; 14:83-89. [PMID: 30785415 PMCID: PMC8102033 DOI: 10.12788/jhm.3129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Choosing Wisely® is a national initiative to deimplement or reduce low-value care. However, there is limited evidence on the effectiveness of strategies to influence ordering patterns. OBJECTIVE We aimed to describe the effectiveness of an intervention to reduce daily chest X-ray (CXR) ordering in two intensive care units (ICUs) and evaluate deimplementation strategies. DESIGN We aimed to describe the effectiveness of an intervention to reduce daily chest X-ray (CXR) ordering in two intensive care units (ICUs) and evaluate deimplementation strategies. SETTING The study was performed in the medical intensive care unit (MICU) and cardiovascular intensive care unit (CVICU) of an academic medical center in the United States from October 2015 to June 2016. PARTICIPANTS The initiative included the staff of the MICU and CVICU (physicians, surgeons, nurse practitioners, fellows, residents, medical students, and X-ray technologists). INTERVENTION COMPONENTS We utilized provider education, peer champions, and weekly data feedback of CXR ordering rates. MEASUREMENTS We analyzed the CXR ordering rates and factors facilitating or inhibiting deimplementation. RESULTS Segmented linear time-series analysis suggested a small but statistically significant decrease in CXR ordering rates in the CVICU (P < .001) but not in the MICU. Facilitators of deimplementation, which were more prominent in the CVICU, included engagement of peer champions, stable staffing, and regular data feedback. Barriers included the need to establish goal CXR ordering rates, insufficient intervention visibility, and waning investment among medical residents in the MICU due to frequent rotation and competing priorities. CONCLUSIONS Intervention modestly reduced CXRs ordered in one of two ICUs evaluated. Understanding why adoption differed between the two units may inform future interventions to deimplement low-value diagnostic tests.
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Affiliation(s)
- Silas P Trumbo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wade T Iams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heather M Limper
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jayme Gibson
- Cardiovascular Intensive Care Unit, Vanderbilt University Medical Center, Nashville Tennessee, USA
| | - Lauren Oliver
- Cardiovascular Intensive Care Unit, Vanderbilt University Medical Center, Nashville Tennessee, USA
| | - David L Leverenz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald W Brady
- Department of Medicine, Vanderbilt University Medical Center, 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wright JP, Edwards GC, Goggins K, Tiwari V, Maiga A, Moses K, Kripalani S, Idrees K. Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. JAMA Surg 2018; 153:137-142. [PMID: 28979989 PMCID: PMC5838587 DOI: 10.1001/jamasurg.2017.3832] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Low health literacy is known to adversely affect health outcomes in patients with chronic medical conditions. To our knowledge, the association of health literacy with postoperative outcomes has not been studied in-depth in a surgical patient population. Objective To evaluate the association of health literacy with postoperative outcomes in patients undergoing major abdominal surgery. Design, Setting, and Participants From November 2010 to December 2013, 1239 patients who were undergoing elective gastric, colorectal, hepatic, and pancreatic resections for both benign and malignant disease at a single academic institution were retrospectively reviewed. Patient demographics, education, insurance status, procedure type, American Society of Anesthesiologists status, Charlson comorbidity index, and postoperative outcomes, including length of stay, emergency department visits, and hospital readmissions, were reviewed from electronic medical records. Health literacy levels were assessed using the Brief Health Literacy Screen, a validated tool that was administered by nursing staff members on hospital admission. Multivariate analysis was used to determine the association of health literacy levels on postoperative outcomes, controlling for patient demographics and clinical characteristics. Main Outcomes and Measures The association of health literacy with postoperative 30-day emergency department visits, 90-day hospital readmissions, and index hospitalization length of stay. Results Of the 1239 patients who participated in this study, 624 (50.4%) were women, 1083 (87.4%) where white, 96 (7.7%) were black, and 60 (4.8%) were of other race/ethnicity. The mean (SD) Brief Health Literacy Screen score was 12.9 (SD, 2.75; range, 3-15) and the median educational attainment was 13.0 years. Patients with lower health literacy levels had a longer length of stay in unadjusted (95% CI, 0.95-0.99; P = .004) and adjusted (95% CI, 0.03-0.26; P = .02) analyses. However, lower health literacy was not significantly associated with increased rates of 30-day emergency department visits or 90-day hospital readmissions. Conclusions and Relevance Lower health literacy levels are independently associated with longer index hospitalization lengths of stay for patients who are undergoing major abdominal surgery. The role of health literacy needs to be further evaluated within surgical practices to improve health care outcomes and use.
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Affiliation(s)
- Jesse P. Wright
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gretchen C. Edwards
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Goggins
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vikram Tiwari
- Department Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amelia Maiga
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelvin Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Boyle J, Speroff T, Worley K, Cao A, Goggins K, Dittus RS, Kripalani S. Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients. J Hosp Med 2017; 12:918-924. [PMID: 29091980 DOI: 10.12788/jhm.2841] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the association of health literacy with the number and type of transitional care needs (TCN) among patients being discharged to home. DESIGN, SETTING, PARTICIPANTS A cross-sectional analysis of patients admitted to an academic medical center. MEASUREMENTS Nurses administered the Brief Health Literacy Screen and documented TCNs along 10 domains: caregiver support, transportation, healthcare utilization, high-risk medical comorbidities, medication management, medical devices, functional status, mental health comorbidities, communication, and financial resources. RESULTS Among the 384 patients analyzed, 113 (29%) had inadequate health literacy. Patients with inadequate health literacy had needs in more TCN domains (mean = 5.29 vs 4.36; P < 0 .001). In unadjusted analysis, patients with inadequate health literacy were significantly more likely to have TCNs in 7 out of the 10 domains. In multivariate analyses, inadequate health literacy remained significantly associated with inadequate caregiver support (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.37-4.99) and transportation barriers (OR, 1.69; 95% CI, 1.04-2.76). CONCLUSIONS Among hospitalized patients, inadequate health literacy is prevalent and independently associated with other needs that place patients at a higher risk of adverse outcomes, such as hospital readmission. Screening for inadequate health literacy and associated needs may enable hospitals to address these barriers and improve postdischarge outcomes.
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Affiliation(s)
- Joseph Boyle
- School of Graduate Medical Education, University of Colorado, Aurora, Colorado, USA
| | - Theodore Speroff
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine Worley
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aize Cao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Dittus
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Center for Health Services Research, 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 Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, 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 Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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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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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Iams W, Heck J, Kapp M, Leverenz D, Vella M, Szentirmai E, Valerio-Navarrete I, Theobald C, Goggins K, Flemmons K, Sponsler K, Penrod C, Kleinholz P, Brady D, Kripalani S. A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing. Acad Med 2016; 91:813-820. [PMID: 27028031 DOI: 10.1097/acm.0000000000001149] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Provision of high-value care is a milestone in physician training. The authors evaluated the effect of a housestaff-led initiative on laboratory testing rates. METHOD Vanderbilt University Medical Center's Choosing Wisely steering committee, led by housestaff with faculty advisors, sought to reduce unnecessary daily basic metabolic panel (BMP) and complete blood count (CBC) testing on inpatient general medicine and surgical services. Intervention services received a didactic session followed by regular data feedback with goal rates and peer comparison. Testing rates during January 1, 2013-February 9, 2015, were compared on intervention services and control services using a difference-in-differences analysis and an interrupted time-series analysis with segmented linear regression. RESULTS Compared with concurrent controls, the mean number of BMP tests per patient day decreased by an additional 0.23 (95% CI 0.17-0.29) on medical housestaff and 0.15 (95% CI 0.09-0.21) on hospitalist intervention services. Daily CBC tests decreased by an additional 0.28 (95% CI 0.23-0.33) on medical housestaff, 0.08 (95% CI 0.03-0.13) on hospitalist, and 0.12 (95% CI 0.05-0.20) on surgical housestaff intervention services. Patients with lab-free days (0 labs ordered in 24 hours) increased by an additional 4.1 percentage points (95% CI 2.1-6.1) on medical housestaff and 9.7 percentage points (95% CI 6.6-12.8) on hospitalist intervention services. There were no adverse changes in length of stay or intensive care unit transfer, in-hospital mortality, or 30-day readmission rates. CONCLUSIONS A housestaff-led intervention utilizing education and data feedback with goal setting and peer comparison resulted in safe, significant reductions in daily laboratory testing rates.
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Affiliation(s)
- Wade Iams
- W. Iams is chief resident in internal medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. J. Heck was chief resident in radiology and musculoskeletal radiology fellow, Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, at the time of implementation and writing. M. Kapp is chief resident in pathology, Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee. D. Leverenz is a third-year internal medicine resident, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. M. Vella is a fourth-year general surgery resident, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. E. Szentirmai is a fourth-year medical student, School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. I. Valerio-Navarrete is data analyst, Department of Informatics, Vanderbilt University Medical Center, Nashville, Tennessee. C. Theobald is assistant professor of medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. K. Goggins is research coordinator, Department of Internal Medicine and Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee. K. Flemmons is assistant professor of medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. K. Sponsler is assistant professor of medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. C. Penrod is a pediatric emergency medicine fellow, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. P. Kleinholz is chief resident in neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee. D. Brady is professor of medicine and designated institutional official, Office of Graduate Medical Education
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Bell SP, Schnipper JL, Goggins K, Bian A, Shintani A, Roumie CL, Dalal AK, Jacobson TA, Rask KJ, Vaccarino V, Gandhi TK, Labonville SA, Johnson D, Neal EB, Kripalani S. Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial. J Gen Intern Med 2016; 31:470-7. [PMID: 26883526 PMCID: PMC4835388 DOI: 10.1007/s11606-016-3596-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. OBJECTIVE The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. DESIGN Randomized, controlled trial with concealed allocation and blinded outcome assessors SETTING Two tertiary care academic medical centers PARTICIPANTS Adults hospitalized with a diagnosis of ACS and/or ADHF. INTERVENTION Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge MAIN MEASURES The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported. KEY RESULTS A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition. CONCLUSION A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.
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Affiliation(s)
- Susan P Bell
- Vanderbilt Center for Translational and Clinical Cardiovascular Research (VTRACC), Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Suite 300-A 2525 West End Avenue, Nashville, TN, 37232-8300, USA.
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN, USA.
| | - Jeffrey L Schnipper
- Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ayumi Shintani
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christianne L Roumie
- Center for Health Services Research, Vanderbilt University, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center, Nashville, TN, USA
| | - Anuj K Dalal
- Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Terry A Jacobson
- Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kimberly J Rask
- Department of Epidemiology, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Stephanie A Labonville
- Department of Pharmacy Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Johnson
- Vanderbilt University, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin B Neal
- Vanderbilt University, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Scarpato K, Kappa S, Goggins K, Chang S, Cookson M, Smith J, Clark P, Penson D, Resnick M, Barocas D, Idrees K, Kripalani S, Moses K. MP31-16 THE IMPACT OF HEALTH LITERACY ON SURGICAL OUTCOMES FOLLOWING RADICAL CYSTECTOMY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wooldridge K, Schnipper JL, Goggins K, Dittus RS, Kripalani S. Refractory primary medication nonadherence: Prevalence and predictors after pharmacist counseling at hospital discharge. J Hosp Med 2016; 11:48-51. [PMID: 26293710 PMCID: PMC4703466 DOI: 10.1002/jhm.2446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/15/2015] [Accepted: 07/30/2015] [Indexed: 01/20/2023]
Abstract
Successful secondary prevention of cardiovascular disease relies on medication therapy; thus, minimizing nonadherence is a focus for improving patient outcomes. Receipt of discharge medication counseling has been associated with improved drug knowledge and adherence. We evaluated the prevalence and predictors of postdischarge primary nonadherence (not filling new prescriptions) in patients who received discharge medication counseling by a pharmacist (ie, refractory to intervention) as part of a randomized controlled trial. Of 341 patients, 9.4% of patients did not fill all prescriptions after discharge. Patients who were living alone were more likely to not fill their medications compared to those who were married or cohabitating (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.01-4.8, P = 0.047). Patients who were discharged with greater than 10 medications were also more likely to demonstrate primary nonadherence (OR: 2.3, 95% CI: 1.05-4.98, P = 0.036). Patients with lower income were less likely to fill prescriptions in univariate analysis (P = 0.04) but not multivariable analysis. Our study demonstrates that among patients hospitalized for acute cardiovascular events, primary medication nonadherence persisted despite discharge medication counseling. Targeted or multimodal approaches that address patient-specific barriers, such as cost, social isolation, and polypharmacy, in addition to discharge counseling, may further facilitate adherence.
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Affiliation(s)
- Kathleene Wooldridge
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey L. Schnipper
- Brigham and Women's Hospital Division of General Medicine and Primary Care, Boston, MA
- Brigham and Women’s Hospital Hospitalist Service, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kathryn Goggins
- Center for Clinical Quality and Implementation Research, Vanderbilt University
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Robert S. Dittus
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Clinical Quality and Implementation Research, Vanderbilt University
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
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21
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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: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Leak C, Goggins K, Schildcrout JS, Theobald C, Donato KM, Bell SP, Schnelle J, Kripalani S. Effect of Health Literacy on Research Follow-Up. J Health Commun 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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. J Health Commun 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Borton M, Neligan M, Wood F, Dervan P, Goggins K, Docherty JR. Contractions to 5-hydroxytryptamine in human coronary artery and human saphenous vein. Br J Clin Pharmacol 1990; 30 Suppl 1:107S-108S. [PMID: 2268504 PMCID: PMC1368106 DOI: 10.1111/j.1365-2125.1990.tb05476.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Isometric contractions were obtained to 5-hydroxytryptamine receptor agonists in human saphenous vein and human coronary artery. Based on the interaction with the 5-HT2 receptor antagonist ketanserin, both 5-HT1 and 5-HT2 receptors are involved in contractions of human saphenous vein, but the predominant subtype involved in contractions of human coronary artery is the 5-HT1 receptor.
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Affiliation(s)
- M Borton
- Department of Clinical Pharmacology, Royal College of Surgeons, Dublin, Ireland
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