Cocchieri Antonello, Cristofori Elena, Nurchis Mario Cesare, Damiani Gianfranco, Cesare Manuele
Section of Hygiene, Woman and Child Health and Public Health, Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy.
Section of Hygiene, Department of Health Science and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy.
Nurs Rep. 2025 Apr 17;15(4):135. doi: 10.3390/nursrep15040135.
Although nursing complexity and health literacy (HL) are critical determinants of patient outcomes, their combined impact on mortality, hospital re-admissions, and emergency department (ED) visits remains poorly understood. This study aims to measure nursing complexity and HL in hospitalized patients, examine their interaction, and analyze their impacts on mortality, hospital re-admissions, and ED visits over a one-year follow-up period. Adult patients from two hospital centers were enrolled, excluding those with stays under two days or cognitive impairments. Data were collected at baseline to assess nursing complexity (measured according to the number of nursing diagnoses assigned to patients within 24 h from hospital admission) and HL (assessed using the Single-Item Literacy Screener, SILS). Patients were followed during a 12-month follow-up period to track mortality, hospital re-admissions, and ED visits. Latent class analysis classified patients into distinct nursing complexity and HL profiles. Survival analyses and Cox proportional hazard models were used to evaluate the relationships between variables. At baseline, among the 2667 enrolled patients, 55.9% were classified as having high nursing complexity, and 32% had inadequate HL. High nursing complexity was associated with lower HL (r = 0.384; < 0.001). During follow-up, 387 patients (14.5%) were lost. Of the remaining sample, mortality occurred in 8.3% of the patients, hospital re-admissions in 27.2%, and ED visits in 16.8%. Nursing complexity was significantly associated with higher mortality (HR: 1.84, adjusted HR: 1.81), but not with hospital re-admissions or ED visits. The patients with inadequate HL (32%) had increased risks of mortality (HR: 11.21, adjusted HR: 7.75), hospital re-admissions (HR: 3.61, adjusted HR: 3.58), and ED visits (HR: 20.78, adjusted HR: 14.45). The patients with both high nursing complexity and inadequate HL had the highest mortality risk and the lowest 12-month survival rate (75%; 95% CI: 71.1-79.1%; < 0.001). This study demonstrates that both high nursing complexity and inadequate HL independently and jointly contribute to adverse patient outcomes. Interventions targeting HL and supporting patients with high nursing complexity could reduce risks, enhance care, and improve patient survival. While these findings underscore the critical role of both factors in patient outcomes, the limitations include this study's single-country setting and reliance on a single-item HL measure. Future research should validate these findings in broader healthcare contexts and integrate multidimensional HL assessments for a more comprehensive evaluation.
尽管护理复杂性和健康素养（HL）是患者预后的关键决定因素，但它们对死亡率、医院再入院率和急诊科就诊的综合影响仍知之甚少。本研究旨在测量住院患者的护理复杂性和HL，研究它们之间的相互作用，并分析它们在一年随访期内对死亡率、医院再入院率和急诊科就诊的影响。来自两个医院中心的成年患者被纳入研究，排除住院时间少于两天或有认知障碍的患者。在基线时收集数据，以评估护理复杂性（根据患者入院后24小时内分配的护理诊断数量进行测量）和HL（使用单项素养筛查工具SILS进行评估）。在12个月的随访期内对患者进行跟踪，以记录死亡率、医院再入院率和急诊科就诊情况。潜在类别分析将患者分为不同的护理复杂性和HL类别。生存分析和Cox比例风险模型用于评估变量之间的关系。在基线时，2667名纳入研究的患者中，55.9%被归类为护理复杂性高，32%的患者HL不足。高护理复杂性与较低的HL相关（r = 0.384；P < 0.001）。在随访期间，387名患者（14.5%）失访。在其余样本中，8.3%的患者死亡，27.2%的患者再次入院，16.8%的患者到急诊科就诊。护理复杂性与较高的死亡率显著相关（HR：1.84，调整后HR：1.81），但与医院再入院率或急诊科就诊无关。HL不足的患者（32%）死亡风险增加（HR：11.21，调整后HR：7.75），医院再入院风险增加（HR：3.61，调整后HR：3.58），急诊科就诊风险增加（HR：20.78，调整后HR：14.45）。护理复杂性高且HL不足的患者死亡风险最高，12个月生存率最低（75%；95%CI：71.1 - 79.1%；P < 0.001）。本研究表明，高护理复杂性和HL不足均独立且共同导致不良患者预后。针对HL并支持护理复杂性高的患者的干预措施可降低风险、改善护理并提高患者生存率。虽然这些发现强调了这两个因素在患者预后中的关键作用，但局限性包括本研究的单一国家背景以及对单项HL测量的依赖。未来的研究应在更广泛的医疗环境中验证这些发现，并整合多维HL评估以进行更全面的评估。
