Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
J Urol. 2017 Sep;198(3):560-566. doi: 10.1016/j.juro.2017.04.018. Epub 2017 Apr 8.
There are few data on the relationship between health literacy and discharge disposition. We hypothesized that patient discharge needs after radical cystectomy are affected by health literacy.
We identified 504 patients who underwent radical cystectomy and completed the validated BHLS (Brief Health Literacy Screen) after November 2010. Bivariate and logistic regression analyses were performed to determine whether health literacy is associated with the use of discharge resources after radical cystectomy.
Of patients treated with radical cystectomy 50.6% required discharge services and had lower health literacy (BHLS 11.9 vs 12.5, p = 0.016) than patients discharged home without services. On multivariable analysis older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002), female gender (OR 2.3, 95% CI 1.2-4.4, p = 0.019), body mass index (OR 1.1, 95% CI 1.0-1.1, p = 0.034), Charlson comorbidity index score (OR 1.1, 95% CI 1.0-1.2, p = 0.037) and length of stay (OR 1.1, 95% CI 1.0-1.2, p = 0.019) were significantly associated with the use of discharge resources. Patients with continent vs incontinent urinary diversion were less likely to require discharge services (OR 0.4, 95% CI 0.2-0.8, p = 0.013).
Older age, female gender, body mass index, comorbidities, length of stay and incontinent diversion are associated with increased use of discharge resources after radical cystectomy. Low health literacy may affect patient discharge disposition but it was not significant on multivariable analysis. Factors that influence the complex self-care required of patients after cystectomy should be considered during discharge planning.
关于健康素养与出院去向之间的关系，数据有限。我们假设根治性膀胱切除术患者的出院需求受到健康素养的影响。
我们确定了 504 名于 2010 年 11 月后接受根治性膀胱切除术并完成了经过验证的 BHLS（简短健康素养筛查）的患者。进行了单变量和逻辑回归分析，以确定健康素养是否与根治性膀胱切除术后使用出院资源相关。
接受根治性膀胱切除术的患者中有 50.6%需要出院服务，且健康素养较低（BHLS 为 11.9 分，而 12.5 分，p=0.016），而无需服务即可出院的患者。多变量分析显示，年龄较大（OR 1.1，95%CI 1.0-1.1，p=0.002），女性（OR 2.3，95%CI 1.2-4.4，p=0.019），体质指数（OR 1.1，95%CI 1.0-1.1，p=0.034），Charlson 合并症指数评分（OR 1.1，95%CI 1.0-1.2，p=0.037）和住院时间（OR 1.1，95%CI 1.0-1.2，p=0.019）与出院资源的使用显著相关。有控尿性与非控尿性尿流改道的患者不太可能需要出院服务（OR 0.4，95%CI 0.2-0.8，p=0.013）。
年龄较大，女性，体质指数，合并症，住院时间和非控尿性改道与根治性膀胱切除术后出院资源的使用增加相关。低健康素养可能会影响患者的出院去向，但在多变量分析中并不显着。在出院计划中应考虑影响患者接受膀胱切除术后复杂自我护理的因素。
