Low "Health Literacy" Increases Hospitalizations

People who have trouble reading and understanding health-related materials are more than twice as likely to wind up in a hospital as those who have adequate health literacy, according to a study at a large inner-city Atlanta hospital.

A two-year study of 979 persons who used the emergency department and walk-in clinic at Atllanta's Grady Memorial Hospital revealed that 31.5 percent of the patients with inadequate health literacy were hospitalized at least once during that period, more than double the 14.9 percent of those who had adequate health literacy.

All participants took a test that measured their ability to read and understand health-related written materials such as a standard informed-consent application, and to comprehend directions for taking medicines, monitoring blood glucose levels, and keeping clinical appointments.

Hospital admissions are a major factor in health care costs, according to David W. Baker, MD, of Case Western Reserve University and MetroHealth Medical Center in Cleveland, and his colleagues at Emory University School of Medicine and Rollins School of Public Health, both in Atlanta. Their findings are reported in the December issue of the Journal of General Internal Medicine.

"After adjusting for other factors, health illiteracy appears to increase the risk of hospital admission by 50 percent," Baker said. He and his colleagues note that their findings have broad implications for millions of Medicare beneficiaries and the Medicare program itself, citing the 1993 National Adult Literacy Survey that classified 44 percent of adults aged 65 and older as functionally illiterate.

"There were approximately 16 million functionally illiterate Medicare beneficiaries (in 1993)," they report. "If these individuals have higher than expected hospital costs, and if these excess hospitalizations could have been prevented by improved communication and education, then Medicare hosp

Contact: David W. Baker, M.D.
Center for the Advancement of Health

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