2052. Low Health Literacy Increases the Risk OF Preventable Hospital Admission
AM Arozullah, VA Chicago Healthcare System, Westside Division, and University of Illinois College of Medicine, SY Lee, University of North Carolina, T Khan, VA Chicago Healthcare System, Westside Division, and University of Illinois College of Medicine, S Kurup, VA Chicago Healthcare System, Westside Division, and University of Illinois College of Medicine

Objectives: To determine the relationship between health literacy and preventability of admission and the causes of preventable admissions.

Methods: We enrolled patients admitted to the medicine service at the Westside VA between 8/1/01-8/1/02. Patients with dementia, blindness, deafness, VA care for < 6 months, observation status admission, and/or being too ill to participate were excluded. Patients were interviewed to assess health literacy, health status, health habits, health service access and utilization, social support, marital status, education, and income. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Two Board-certified VA Internists, blinded to survey results, determined preventability by reviewing charts (blinded to patient and providers) that included outpatient notes from one month prior to admission, admission day clinic, emergency department, and admitting notes, nursing evaluations, orders, and laboratory or radiology reports available within 24 hours of admission. Logistic regression models were used to determine the relationship between literacy and preventable hospitalization.

Results: To date, we have completed surveys and chart reviews for 198 patients. The mean age was 62.2 years (SD, 13.4), 69% had <9th grade literacy level, and 39% of admissions were rated as preventable. After adjustment for age, health status, presence of a personal physician, number of doctor visits in past year, social support, marital status, education, and income, patients with <=3rd grade literacy had an odds ratio (OR) of 8.5 (95% CI, 1.9-38.4) for preventable admission compared to those with >8th grade literacy. Patients with 4-8th grade literacy had an OR of 2.5 (95% CI, 1.1-5.7) for preventability. Other significant risk factors included heavy alcohol use (OR 8.1, 95% CI 1.8-36.8), communication difficulty with providers (OR 4.9, 95% CI 1.7-14.2), depression (OR 3.3, 95% CI 1.5-7.0), and recent hospitalization (OR 0.8, 95% CI, 0.6-1.0).  For patients with <= 6th grade literacy, 71% of preventable admissions were related to system-level factors compared to 39% for those with >6th grade literacy (p<0.01).

Conclusions: Patients with low health literacy are at increased risk for preventable admission. Other risk factors include heavy alcohol use, communication difficulty, depression, and fewer recent hospitalizations.

Impact: Many admissions among low literacy patients may be preventable, but will likely require system-level interventions.  Routine literacy screening may reduce hospitalization rates by increasing provider awareness of potential communication difficulties.