From the Department of Surgery (J.A.W., M.Z.S., K.M.C., S.I., M.D.J., J.V.J., J.N.B.), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
J Trauma Acute Care Surg. 2019 Nov;87(5):1214-1219. doi: 10.1097/TA.0000000000002465.
Although the impact of health literacy (HL) on trauma patient outcomes remains unclear, recent studies have demonstrated that trauma patients with deficient HL have poor understanding of their injuries, are less likely to comply with follow-up, and are relatively less satisfied with physician communication. In this study, we sought to determine if HL deficiency was associated with comprehension of discharge instructions.
In this prospective study, hospitalized trauma patients underwent evaluation of HL prior to discharge. Newest Vital Sign (NVS) instrument was used to score HL as deficient, marginal, or proficient. Three days postdischarge, patients were telephonically administered a six-point scored questionnaire regarding comprehension of discharge instructions. A general linear model was used to determine the association between HL and comprehension of discharge instructions.
Sixty-three patients were administered both NVS and discharge instruction questionnaire. Ten (15.9%) patients scored as deficient in HL on the NVS screen, 16 (25.4%) as marginally proficient, and 37 (58.7%) as proficient. The HL proficiency significantly predicted follow-up score with increasing proficiency associated with higher scores on the discharge comprehension assessment (p < 0.001). Adjusted mean scores (± SE) for deficient, marginal, and proficient patients were 2.8 ± 0.5, 3.2 ± 0.4, and 4.7 ± 0.2. Post hoc comparisons demonstrated significant differences between proficient with marginal proficiency (p = 0.002) and deficient proficiency (p = 0.001).
Performance on bedside test of HL among trauma inpatients predicted ability to comprehend instructions following hospital discharge. This study supports the value of HL screening prior to discharge. The HL-deficient patients may benefit from a transitional care program to improve comprehension of discharge instructions after leaving the hospital.
Therapeutic/Care Management, level III.
尽管健康素养（HL）对创伤患者结局的影响尚不清楚，但最近的研究表明，HL 不足的创伤患者对其损伤的理解能力较差，不太可能遵循随访，并且对医生沟通的满意度相对较低。在这项研究中，我们试图确定 HL 缺陷是否与对出院指导的理解有关。
在这项前瞻性研究中，住院创伤患者在出院前接受 HL 评估。使用最新生命体征（NVS）工具对 HL 进行评分，分为缺陷、边缘和熟练。出院后 3 天，通过电话向患者发放了一份六分制问卷，以评估其对出院指导的理解。使用一般线性模型来确定 HL 与出院指导理解之间的关联。
对 63 名患者进行了 NVS 和出院指导问卷的评估。10 名（15.9%）患者在 NVS 屏幕上 HL 缺陷，16 名（25.4%）为边缘熟练，37 名（58.7%）为熟练。HL 熟练程度显著预测随访评分，随着熟练程度的提高，出院理解评估的得分也更高（p < 0.001）。缺陷、边缘和熟练患者的调整平均得分（± SE）分别为 2.8 ± 0.5、3.2 ± 0.4 和 4.7 ± 0.2。事后比较显示，熟练与边缘熟练（p = 0.002）和缺陷熟练（p = 0.001）之间存在显著差异。
在住院创伤患者中进行床边 HL 测试的表现预测了出院后理解指导的能力。这项研究支持在出院前进行 HL 筛查的价值。HL 缺陷患者可能受益于过渡护理计划，以提高离开医院后对出院指导的理解。
治疗/护理管理，III 级。
