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Hospitals serving higher concentrations of Medicaid patients and more racial/ethnic diverse patients experienced a less satisfactory patient experience than patients utilizing other payers or patients who were White. Our research magnifies the challenge for addressing the disparities that exist in healthcare. Further research is called for clarifying the underlying reasons for these disparities and the optimal strategies for addressing these problems.

BackgroundHealth literacy (HL) refers to the ability to obtain, read, understand, and use basic health care information required to make appropriate health decisions and follow instructions for treatment. The Newest Vital Sign (NVS) is an instrument developed for assessing aspects of HL relevant to reading and numeracy skills. This study aimed to develop a traditional Chinese version of the NVS (NVS-TC) and assess its feasibility, reliability, and validity in Taiwanese patients with type 2 diabetes.MethodsThe original NVS was translated into traditional Chinese in accordance with established guidelines. A cognitive testing procedure was subsequently performed to evaluate the ease of understanding and acceptability of the test in 30 patients with diabetes. Thereafter, a quantitative survey (N = 232) was administered for validating the NVS-TC against the accepted standard tests of HL and participant education level.ResultsThe internal consistency (Cronbach's α) was 0.76. In accordance with a priori hypotheses, we found strong associations between the NVS-TC and objective HL and weaker associations between the NVS-TC and subjective HL. The known group validity of the NVS-TC was demonstrated through multivariate regression analyses, which showed that educational differences in the NVS-TC scores remained significant after adjustment for age, gender, and working in healthcare.ConclusionsThe results suggest that the NVS-TC is a reliable and valid tool that facilitates international comparable HL research in Taiwan. The NVS-TC can be used to investigate the role of HL in health care and can be easily incorporated into daily clinical practice for diabetes management.

The aim of this study was to investigate whether adopting healthy lifestyle habits, such as engaging in leisure time physical activity (LTPA), adopting recommended dietary patterns, and not smoking, are associated with reduced hospitalizations over 1 year among adults with diabetes. We analyzed data from a national sample of people aged 18 years and above with self-reported physician-diagnosed diabetes (n = 664) through linkage to the 2001 National Health Interview Survey in Taiwan and the 2002 National Health Insurance claims data. Multivariate analysis showed that participants reporting greater than 150 min/wk of moderate-intensity activity had a significantly lower chance for hospitalization (odds ratio = 0.52; 95% confidence interval [CI] = 0.27-0.98), fewer admissions (incidence rate ratio [IRR] = 0.58; 95% CI = 0.33-1.00), and fewer hospital bed days (IRR = 0.42; 95% CI = 0.20-0.92) compared with inactive individuals. Diet control and smoking status did not significantly predict hospital use after controlling for other factors. Our findings indicate that increased LTPA results in reduced hospitalization among adults with diabetes.