Teachable moment

Lack of health literacy leads to dramatic hike in preventable ER visits

By Bill Levesque

Patients unable to adequately understand basic health information are more than twice as likely to experience a preventable emergency room visit resulting in hospitalization, according to a recent study by University of Florida researchers.

Researchers said this lack of health literacy underscores the need for physicians to assess their patients’ understanding of their medical care and to provide clear, easily understood instructions when such understanding appears lacking.

One simple suggestion is to have patients with limited health literacy repeat back instructions received from their doctor to ensure comprehension.

“Sometimes patients are given so much information, they just get lost in it,” said Meenakshi Balakrishnan, M.P.H., Ph.D., lead author of the study and research project manager for UF department of emergency medicine. “We need to focus on just keeping the message simple, keeping it to one or two bullet points or action items for the patient.”

ER visits that could have been prevented with high-quality outpatient care contribute to waste and inefficiency in the health care system, delay
care for patients and increase expense, according to the study, published in the journal Academic Emergency Medicine.

“While we can’t change the health literacy of a person, we can always tailor the message,” said Balakrishnan. “That is the key point of our paper.”

The study assessed the health literacy of 1,201 patients visiting UF Health’s main emergency room for 18 months ending in December 2015. Each was given a brief reading recognition test that comprised 66 health-related words in ascending order of difficulty, such as flu, kidney, hormones, jaundice and osteoporosis.

The patients were asked to read the words aloud and were scored on their ability to read them correctly. Balakrishnan said the test, which can be shortened to as few as seven words, is a highly validated method of assessing health literacy.

Of those 1,201 patients, 33 percent (394) had limited health literacy, the study said. After a review of health records and interviews with patients, the study found that 9.5 percent (423) of their 4,444 total emergency room visits were potentially preventable.

Of those, 61 percent (260) resulted in a hospital admission. Patients with limited health literacy had 2.3 times the number of potentially preventable ER visits that resulted in hospitalization compared with patients with adequate health literacy, the study showed.

Balakrishnan acknowledged preventable emergency room visits have causes that often go beyond a patient’s health literacy. Access to quality outpatient care, for example, can be a key contributor.

Balakrishnan said she recognizes doctors are extremely busy, especially in an emergency room. But she said the extra conversation to clearly explain the cause and course of the patients’ symptoms and to confirm the patients’ understanding of treatment options may have an outsized impact.

“I have talked to a few physicians in our department, and they think it is feasible,” Balakrishnan said. “They have to want to do this, firstly. But I think once they cross that barrier, they can easily accomplish it.”

Co-authors of the study are Jill Boylston Herndon, Ph.D., an associate professor in UF’s department of community dentistry; Jingnan Zhang, Ph.D., a biostatistician at Pfizer who received her doctorate at UF; Thomas Payton, M.D., M.B.A., vice chair of operations in UF’s emergency department and an assistant professor; Jonathan Shuster Ph.D., a professor emeritus in health outcomes and policy; and senior author Donna L. Carden M.D., M.P.H., a professor in UF’s department of emergency medicine.