Low health literacy linked to longer LOS, more transitional care needs

The link between health literacy and length of stay (LOS) was significantly impacted by gender but not by illness severity or older age.


Inadequate health literacy is associated with longer length of stay (LOS) and greater transitional care needs, according to two studies published online on Sept. 20 by the Journal of Hospital Medicine.

In the LOS study, researchers administered the Brief Health Literacy Screen to 5,540 hospitalized general medicine patients and found that 1,104 (20%) had low health literacy. Compared to patients with adequate health literacy, those with low health literacy had a longer average LOS (6.0 vs. 5.4 days; P<0.001). In multivariate analysis, low health literacy was associated with an 11.1% longer LOS (95% CI, 6.1% to 16.1%; P<0.001).

The link between health literacy and LOS was significantly impacted by gender (P=0.02) but not by illness severity or older age. Low health literacy was associated with a 17.8% longer LOS in men (95% CI, 10.0% to 25.7%; P<0.001) and a 7.7% longer LOS in women (95% CI, 1.9% to 13.5%; P=0.009). The researchers noted limitations of the study, such as its observational, single-center design and the fact that the largely urban, minority sample (73% black) is not representative of the U.S. population.

In the second study, nurses administered the Brief Health Literacy Screen to 384 patients discharged to home, and 113 (29%) had inadequate health literacy. Nurses documented patients' transitional care needs in 10 domains: caregiver support, transportation, health care utilization, high-risk medical comorbidities, medication management, medical devices, functional status, mental health comorbidities, communication, and financial resources.

Compared to those with adequate health literacy, those with inadequate health literacy had needs in more transitional care domains (mean, 5.29 vs. 4.36; P<0.001). The needs were most commonly identified in the domains of high-risk comorbidities (98.4%), frequent or prior health care utilization (76.6%), medication management (76.3%), functional status (54.9%), and transportation (48.7%).

After adjustment for demographic factors, patients with low health literacy were significantly more likely to have inadequate caregiver support (odds ratio, 2.61; 95% CI, 1.37 to 4.99) and transportation barriers (odds ratio, 1.69; 95% CI, 1.04 to 2.76).

“The prevalence of these needs highlights the importance of using a structured assessment to identify patient concerns so that they may be addressed through discharge planning and follow-up,” the study authors wrote. They noted limitations to the study, such as its single-center design and the fact that the transitional care needs assessment was developed for the study and was not formally validated.