Potential Impact of Health Literacy on Readmission Rates, Health Outcomes, and Its Implications for Public Health Practice
Creators: name: Eber, Sarah J.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2012

description: Background: The cost of healthcare in the United States is among the highest in the world yet our health outcomes are also among the poorest in the world (IOM 2003). The cost of healthcare and how to reduce it have been of intense focus in United States economic discussions for several years (National Research Council (NRC) 2010). With the recent changes in healthcare delivery stemming from the Affordable Care Act, both private and public health care insurers are looking for ways to reduce cost and increase patient outcomes (Centers for Medicare and Medicaid Service (CMS) 2010). Centers for Medicare and Medicaid Service (CMS) have targeted identifying the underlying causes of unnecessary hospital readmissions as an area for more intense study to reduce the cost of care and improve outcomes (CMS 2012). The Agency for Healthcare Research and Quality (AHRQ) is focusing efforts to develop evidence-base for patient centered medical homes to improve care outcomes in outpatient settings and control costs while increasing incentives for providers to develop and implement practice standards based on the evidence-based models (2010). Methods: A literature search was conducted using PubMed, Google Scholar, and Cochrane Library resources to assess for the depth and extent of research and evidence-based guidelines for assessing health literacy in a population and interventions that improve health outcomes and provide health-care cost savings. Many of these sources are available in peer-reviewed journals and in project reports from community-based participatory research studies and independently supported projects by the Robert Wood-Johnson Foundation (RWJF) ( 2012) and the Missouri Foundation for Health (MFH)(2012). Additional sources of information will include past studies assessing health literacy in chronic disease outcomes and tool kits and resources developed by the Institute for Healthcare Improvement (IHI, 2012), Health Literacy Studies at the Harvard School of Medicine and the AHRQ (2010) (DeWalt et al., 2010). Results: Low health literacy has been identified as a contributing factor in patient safety and negative health outcomes (Berkman 2011). Yet, very little research has been conducted to develop and test best-practice models, measure the impact of health literacy interventions on individual and population outcomes, or prove cost effectiveness of screening for low health literacy and integrating health literacy concepts into applied interventions (Berkman, et al., 2011; Rosenbaum et al., 2007; NIH, 2012; Rutherford et al., 2004; Parker, Ratzan, Lurie, 2003; Paasche-orlow, 2011). While clinical medicine and public health practitioners have acknowledged the need for culturally sensitive health education material written/spoken/presented in plain language, the evidence-base to support the efficacy of this premise is still emerging. Conclusions: Despite the lack of best-practice models, several strategies have emerged which can be easily integrated into standard operating procedures to improve health literacy, improve patient satisfaction and safety, and contribute to improved outcomes at nominal cost. This paper will review key findings from the literature related to emerging strategies integrating health literacy training and applications to reduce readmissions, to improve patient outcomes in primary and acute care settings for people with chronic illness. It will also suggest strategies, implications, and suggestions for future study in the areas of public health and clinical medicine practice. This paper will also suggest collaborative strategies to improve the health of the population, enhance the patient experience, and reduce or control costs (IHI 2012).