Time, Costs, and Clinical Utilization of Screening for Health Literacy: A Case Study Using the Newest Vital Sign (NVS) Instrument

Welch, Verna L; VanGeest, Jonathan B.; Caskey, Rachel

doi:10.3122/jabfm.2011.03.100212

Cited by 35 publications

(38 citation statements)

References 29 publications

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“…Previous studies [12][13][14][15][16] examining associations between healthcare utilization, expenditures and health literacy were limited to individual-level interpretations given their measurement approaches. [12][13][14][15][16] To address this shortcoming, we conducted the current study, which is multilevel (eg, a Predicted expenditure and number of visits are adjusted for person's type of insurance coverage and region.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16] To address this shortcoming, we conducted the current study, which is multilevel (eg, a Predicted expenditure and number of visits are adjusted for person's type of insurance coverage and region. Visits are modeled with non-negative binomial regression.…”

Section: Discussionmentioning

confidence: 99%

“…11 The relationship between health literacy, healthcare utilization and associated expenditures is of particular importance for the US economy. Studies [12][13][14][15][16] on this issue have typically used validated scales to directly measure health literacy for individuals rather than assess community-level indicators of health literacy. Examples of direct methods include the Rapid Estimate of Adults' Literacy, the Test of Functional Health Literacy in Adults, and the Newest Vital Sign.…”

Section: Introductionmentioning

confidence: 99%

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Health Literacy Impact on National Healthcare Utilization and Expenditure

Rasu

Bawa

Suminski

et al. 2015

Int J Health Policy Manag

185

137

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Background: Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Methods: Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA ® 11.0 statistical software. Results: The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from [2005][2006][2007][2008]. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about $172 billion. Conclusion: Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs. Implications for policy makers• Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. •We found that individuals with below basic or basic compared to above basic health literacy incurred more healthcare visits, have greater total healthcare expenditures. • Adults with basic or below basic health literacy incurred greater costs for prescription ($3362) than adults w...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Health Literacy Impact on National Healthcare Utilization and Expenditure

Rasu

Bawa

Suminski

et al. 2015

Int J Health Policy Manag

185

137

View full text Add to dashboard Cite

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“…37 These researchers, however, used the NVS as a self-administered tool, which was not how the instrument was developed, and validated. The researchers concluded that while primary care practitioners were willing to employ new communication strategies based on fi nding of the NVS, the practitioners tended to revert to usual practice quite rapidly, thus abandoning the information provided by the NVS.…”

Section: Clinical Usementioning

confidence: 99%

Clinical Assessment of Health Literacy

Nemmers¹,

Jorge²

2013

Topics in Geriatric Rehabilitation

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Limited health literacy has been associated with adverse health outcomes in the older adult population. Minimizing the negative impact of limited health literacy in the rehabilitative setting is essential to achieve optimal outcomes. Clinical assessment of health literacy identifi es those patients who experience limited health literacy, thus allowing for customization of the practitioner-patient interaction to address the patient's limited health literacy. To use current assessment instruments, practitioners must understand the purpose and limitations of each instrument. The purposes of this article were to ( a ) provide a brief background on clinical assessment of health literacy, ( b ) describe health literacy assessment instruments commonly used, ( c ) discuss the value of conducting clinical measurement of health literacy, and ( d ) discuss research examining the use of health literacy assessment in the clinical environment. Key words: health literacy , health literacy assessment , health literacy instruments , older adult , rehabilitation in the area of health literacy uses measurement instruments to assess literacy levels. These assessment instruments use word recognition, comprehension, numeracy, or a combination of comprehension and numeracy when assessing health literacy levels. Assessment instruments vary in the type of assessment, the time that is taken for administration, and the fi nal health literacy category. The more comprehensive health literacy measurement instruments will yield a reading grade level whereas shorter screening tools may simply indicate adequate or inadequate health literacy levels. Instruments to assess oral literacy skills have yet to be validated.The purposes of this article were to ( a ) provide a brief background on clinical assessment of health literacy, ( b ) describe health literacy assessment instruments commonly used, ( c ) discuss the value of conducting clinical measurement of health literacy, and ( d ) discuss research examining the use of health literacy assessments in the clinical environment. BACKGROUND ON CLINICAL ASSESSMENT OF HEALTH LITERACYHealth care providers commonly use word recognition or reading comprehension instruments to evaluate the health literacy skills of individuals in a clinical setting. The Rapid Estimate of Adult Literacy in Medicine (REALM) 10 and the Test of Functional Health Literacy (TOFHLA) 11 are considered to be the "gold standard" assessment instruments most widely used in health literacy research. The REALM assesses a patient's ability to read and correctly pronounce medical terms 10 whereas the TOFHLA 11 assesses both reading comprehension and numerical ability. These instruments have been used in evaluating a wide variety of patient populations. Both instruments provide an estimate of the patient's health literacy skills through direct versus self-report measurement and provide a detailed estimate for research purposes. However, these assessment instruments are time consuming and may not be ideal in the dayto-day busy clinical setti...

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“…In one office, 11 an attempt to implement a health literacy instrument was not particularly sustainable, probably at least partly because its value in the clinical setting was elusive. Bluestein 12 looked at factors associated with the acceptance of behavioral treatments for insomnia.…”

Section: Health Literacy Screening Of Unclear Practical Helpmentioning

confidence: 99%

Exciting Research Studies on Practical Medical Problems and Health Services Delivery

Bowman¹,

Neale²

2011

The Journal of the American Board of Family Medicine

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Major articles with major findings are in this issue. Patient-centered medical care is associated with large decreases in medical care costs! Pelvic examinations can lead to increased symptoms and infections. What should we do? Maternal postpartum depression is related to poorer infant health care quality of life at least until 16 months of age, but cannot be detected until well into the immediate postpartum time period. Using the Colorado Asthma toolkit, practices can significantly improve their management of asthma. Smoking has implications for asthma and its management. Healthy patients often do not understand their insurance, nor why they need it if they are healthy. Younger women are not aware of the potential teratogenic harms of their diabetes and hypertension medicines. Insomnia patients often will accept behavioral treatments. A health literacy screening was not of much practical help in one office. Obesity should be a documented medical problem and is an accepted topic for group medical visits. Patient-Centered Care Lowers Medical CostsNews flash: patient-centered care is associated with less use of health care services and lower medical expenditures.1 There was a fairly dramatic difference in charges: 50%. When controlling for multiple other factors, more patient-centered care was associated with a 15% (for women patients) and 31% (for men) decrease in cost over the ensuing year; it is interesting to note the sex difference. Impressively, the decreased utilization was diffuse across specialty visits, ancillary testing, and even hospitalization despite the relatively small number of patients (n ϭ 509). The physicians were secondand third-year residents, so perhaps the differences would not be as great if they were attending physicians. Increasing the ability of physicians to provide patient-centered care could decrease costs, providing more dollars to care for those who are currently underserved. What Are the Negative Effects of a Pelvic Examination?What about urinary symptoms or urinary tract or vaginal infections? We do so many pelvic exams, but mostly we think of emotional consequences, such as women fearing the examination itself or the possible results (diagnosis of sexually transmitted diseases or an abnormal Papanicolaou smear). However, Tiemstra et al 2,3 present new data that suggest that women have more urinary symptoms (prospective and retrospective study), more vaginal symptoms (retrospective study), and are more likely to have actual urinary tract infections (retrospective chart review). The authors' points were reinforced when I (MAB) recently saw 2 patients with urinary tract infections that they blamed on recent pelvic exams. More study needs to be done, but these results are intriguing and suggest we need more work on whether pelvic exams cause problems and how to prevent such negative outcomes.

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Time, Costs, and Clinical Utilization of Screening for Health Literacy: A Case Study Using the Newest Vital Sign (NVS) Instrument

Cited by 35 publications

References 29 publications

Health Literacy Impact on National Healthcare Utilization and Expenditure

Health Literacy Impact on National Healthcare Utilization and Expenditure

Clinical Assessment of Health Literacy

Exciting Research Studies on Practical Medical Problems and Health Services Delivery

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