A Prospective Observational Study Assessing the Impacts of Health Literacy and Psychosocial Determinants of Health on 30-day Readmission Risk

Ojas A Deshpande; John A Tawfik; Aram A Namavar; KimNgan P Nguyen; Sitaram S Vangala; Tahmineh Romero; Neil N Parikh; Erin P Dowling

doi:10.1177/23743735221079140

A Prospective Observational Study Assessing the Impacts of Health Literacy and Psychosocial Determinants of Health on 30-day Readmission Risk

J Patient Exp. 2022 Feb 16:9:23743735221079140. doi: 10.1177/23743735221079140. eCollection 2022.

Authors

Ojas A Deshpande^{1

2}, John A Tawfik^{1

3}, Aram A Namavar^{1

4}, KimNgan P Nguyen¹, Sitaram S Vangala¹, Tahmineh Romero¹, Neil N Parikh^{1

5}, Erin P Dowling^{1

5}

Affiliations

¹ University of California, Los Angeles, CA, USA.
² California Health Sciences University College of Osteopathic Medicine, San Bernardino, CA, USA.
³ California Health and Science University - School of Osteopathic Medicine, Clovis, CA, USA.
⁴ University of California, San Diego, CA, USA.
⁵ University of California, Los Angeles Health Department of Medicine, Los Angeles, CA, USA.

Abstract

Our objective was to assess the utility of an assessment battery capturing health literacy (HL) and biopsychosocial determinants of health in predicting 30-day readmission in comparison to a currently well-adopted readmission risk calculator. We also sought to capture the distribution of inpatient HL, with emphasis on inadequate and marginal HL (an intermediate HL level). A prospective observational study was conducted to obtain HL and biopsychosocial data on general medicine inpatients admitted to the UCLA health system. Five hundred thirty-seven subjects were tracked prospectively for 30-day readmission after index hospitalization. HL was significantly better at predicting readmission compared to LACE + (Length, admission acuity, comorbidities, emergency room visits) alone (P = .013). A multivariate model including education, insurance, and language comfort was a strong predictor of adequate HL (P < .001). In conclusion, HL offered significant improvement in risk stratification in comparison to LACE + alone. Patients with marginal HL were high-risk, albeit difficult to characterize. Incorporating robust HL and biopsychosocial determinant assessments may allow hospital systems to allocate educational resources towards at-risk patients, thereby mitigating readmission risk.

Keywords: 30-day readmission; AURA; LACE +; TOFHLA; health literacy; health outcomes; healthcare language barriers.; hospital medicine; marginal health literacy; observation; patient education; predictive analysis; social determinants.