Longer hospital stay linked to low health literacy

The article below was published on October 11, 2017 by Clinical Advisor, written by Madeline Morr.

Low health literacy is associated with a longer hospital length of stay among general medicine patients, according to a study published in the Journal of Hospital Medicine.

Ethan G. Jaffee, MD, from Massachusetts General Hospital in Boston, and colleagues conducted an in-hospital cohort study of patients who were admitted or transferred to the general medicine service at the University of Chicago between October 2012 and November 2015. Those who died during hospitalization or whose discharge status was missing were excluded.

Health literacy was screened using the Brief Health Literacy Screen (BHLS), which included 3 questions: 1) How confident are you in filling out medical forms on your own?; 2) How often do you have someone help you read hospital materials?; and 3) How often do you have problems learning about your medical condition because of difficulty understanding written information?

Responses to the questions were scored on a 5-point Likert scale, in which higher scores corresponded with higher health literacy. Length of hospital stay was counted from the date of admission to the hospital, with patients being discharged on the same day as admission counted with a hospital stay of 1.

A total of 5,983 participants met inclusion criteria and completed the hospital length assessment. Of these participants, 75 (1%) died during hospitalization, 9 (0.2%) had missing discharge status, 79 (1%) had a length of stay greater than 30 days, and 280 (5%) were missing data on sociodemographic variables. A total of 5,540 patients remained, with a median age of 57 years. The sample was divided into those with private insurance (25%), those with Medicare (46%), and those with Medicaid (26%).

Using the BHLS screen, 20% (1104/5540) had inadequate health literacy. Patients with low health literacy had an 11% longer average length of stay (6.0 vs 5.4 days). Among men, low health literacy was associated with a 17.8% longer length of stay, and among women, low health literacy was associated with a 7.7% longer length of stay.

“We found that low health literacy was associated with a longer hospital length of stay, a result which remained significant when controlling for severity of illness and sociodemographic variables and when testing the model for sensitivity to the highest values of length of stay and illness severity,” the authors said. “Additionally, the association of health literacy with length of stay appeared concentrated among participants with shorter length of stay.”