The Association Between Health Literacy and Preventable Hospitalizations in Missouri: Implications in an Era of Reform

Authors

  • Robert J. Cimasi Health Capital Consultants
  • Anne P. Sharamitaro Health Capital Consultants
  • Rachel L. Seiler Health Capital Consultants

Abstract

Objective: To evaluate the association between health literacy and preventable hospitalizations on a population level in Missouri, and the extent to which differing levels of health literacy are associated with county preventable hospitalization rates and associated charges.

Data Sources/Study Setting: Secondary data from the 2008 Missouri Information for Community Assess-ment and Missouri Health Literacy Mapping Tool was used to determine health literacy and preventable hospitalization rates for the 114 counties and city of St. Louis comprising Missouri.

Study Design: Using correlation analysis, simple hierarchical regression models and nonparametric analysis, we investigated whether lower health literacy rates were associated with increased levels of preventable hospitalizations and charges, by county.

 

Principal Findings: Health literacy was found to be inversely associated with preventable hospitalization rates on a population level, accounting for 21 percent of the variation in preventable hospitalization rates. Prevent-able hospitalization rates significantly differed for counties with the highest and lowest health literacy levels. Conclusions: Lower levels of health literacy are signifi cantly associated with increased rates of preventa-ble hospitalizations and charges in a population-level analysis of Missouri counties. Additional research is needed to quantify the effects of successful community health literacy interventions.

Author Biographies

  • Robert J. Cimasi, Health Capital Consultants

    Robert J. Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, serves as Chief Executive Officer of Health Capital Consultants (HCC), a nationally recognized health care financial and economic consulting firm headquartered in St. Louis, Missouri, serving clients in 49 states since 1993. Mr. Cimasi has over 30 years of experience in serving clients, with a professional focus on the financial and economic aspects of health care service sector entities including: valuation consulting and capital formation services; health care industry transactions including joint ventures, mergers, acqui- sitions, and divestitures; and certificate-of-need and other regulatory and policy planning consulting.

    Mr. Cimasi holds a Masters in Health Administra- tion from the University of Maryland, as well as several professional designations. He is a nationally known speaker on health care industry topics, the author of several books, the latest of which include Accountable Care Organizations: Value Metrics and Capital For- mation (Taylor & Francis, a division of CRC Press, 2013), The Adviser’s Guide to Healthcare, Vols. I, II & III (AICPA, 2010), and The U.S. Healthcare Certificate of Need Sourcebook (Beard Books, 2005). His most recent book entitled Healthcare Valuation: The Finan- cial Appraisal of Enterprises, Assets, and Services will be published by John Wiley & Sons in the Fall of

    2013. Mr. Cimasi is the author of numerous additional chapters in anthologies; books, and legal treatises; published articles in peer reviewed and industry trade journals; research papers and case studies; and, is often quoted by health care industry press. 

  • Anne P. Sharamitaro, Health Capital Consultants

    Anne P. Sharamitaro, Esq., is the Executive Vice Presi- dent & General Counsel of Health Capital Consultants (HCC), where she focuses on the areas of Certificate of Need (CON); regulatory compliance, managed care, and antitrust consulting. Ms. Sharamitaro is a member of the Missouri Bar and holds a J.D. and Health Law Certificate from Saint Louis University School of Law, where she served as an editor for the Journal of Health Law, published by the American Health Lawyers Asso- ciation. Ms. Sharamitaro has co-authored articles in peer reviewed and trade journals, research papers, and chapters in books and anthologies. 

  • Rachel L. Seiler, Health Capital Consultants

    Rachel L. Seiler, MPH, is a Senior Research Asso- ciate at Health Capital Consultants (HCC). Ms. Seiler obtained her Masters in Public Health— Epidemiology & Environmental and Occupational Health from St. Louis University. She has published articles in peer reviewed journals and has presented before Academy Health in 2009 and 2011. 

References

Olson, LK, “Medicaid, the States and Health- care Reform,” New Political Science 34(1): 37-54 (March 2012).

Gilmer, T and RG Kronick, “Differences in the Volume of Services and in Prices Drive Big Variations in Medicaid Spending by States and Regions,” Health Affairs 30(7):1316– 1324 (2011).

Blouin, A, J Hill, K Funk, and E Lucier, “Mis- souri’s Budget Crisis: The Impact on Access to Health Care Cuts, Consequences and Policy Options to Restore Health.” p. 1, 4 (February 2005). Available at: http://www.mobudget. org/files/restorehealth.pdf, accessed on May 19, 2012.

. Barker, MR, “Missouri Medicaid Basics: Spring 2011.” Missouri Foundation for Health, p. 1, 7 (2011). Available at: http://www.mffh.org/ mm/files/MedicaidBasics2011.pdf, accessed May 19, 2012.

Centers for Medicare & Medicaid Services, “Missouri Medicaid Statistics.” Available at: http://www.medicaid.gov/Medicaid-CHIP- Program-Information/By-State/missouri.html, accessed on May 22, 2012.

Supra, n.4.

Patient Protection and Affordable Care Act,

Pub. L. No. 111-148, § 2001, § 10203, 124

Stat. 271, 927 (March 23, 2010). 8. Supra, n.4.

Levi, J, LM Segal, and C Juliano, “Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities,” p. 4 (2009). Available at: http:// healthyamericans.org/reports/prevention08/ Prevention08.pdf, accessed May 21, 2012.

Levi, J, R St. Laurent, LM Segal, and S Vinter, “Shortchanging America’s Health: A State- by-State Look at how Public Health Dollars are Spent and Key State Health Facts,” p. 5, 9 (2010). Available at: http://healthyamericans. org/assets/files/TFAH2010 Shortchanging05. pdf, accessed December 7, 2011; Levi, J, LM Segal, R St. Laurent, and A Lang, “Investing in America’s Health: A State by State Look at Public Health Funding and Key Health Facts.” p. 6, 9 (2012). Available at: http:// healthyamericans.org/assets/files/Investing. pdf, accessed May 19, 2012.

Baker, DW, RM Parker, MV Williams, WS Clark, and J Nurss, “The Relationship of Patient Reading Ability to Self-Reported Health and Use of Health Services,” American Journal of Public Health 87(6):1027–1030 (1997).

Kutner, M, E Greenberg, Y Jin, and C Paulsen,

The Health Literacy of America’s Adults: Results From the 2003 National Assess- ment of Adult Literacy (NCES 2006–483), Washington, DC: National Center for Educa- tion Statistics, p. 2, 10, 18 (2006).

Nielsen-Bohlman, L, AM Panzer, DA Kindig,

Health Literacy: A Prescription to End Confu- sion, Washington DC: National Academies Press (2004); Selden, CR, Zorn, M, Ratzan, SC, and Parker, RM, Editors, National Library of Medicine Current Bibliographies in Medi- cine: Health Literacy, Vol. NLM, Pub. No. CBM 2000-1. Bethesda, MD: National Insti- tutes of Health, US Department of Health and Human Services (2000).

Supra, n.12.

Freedman, DA, Bess, KD, Tucker, HA, Boyd,

DL, Tuchman, AM, and Wallston, KA, “Public Health Literacy Defined,” American Journal of Preventive Medicine 36(5):446–451 (2009).

US Department of Health and Human Ser- vices, Office of Disease Prevention and Health Promotion, National Action Plan to Improve Health Literacy, Washington, DC: p. 4–6 (2010).

Billings, J, L Zeitel, J Lukomnik, TS Carey, AE Blank, and L Newman, “Impact of Socioeco- nomic Status on Hospital Use in New York City,” Health Affairs 12(1):162–173 (1993); Billings, J and RM Weinick, Monitoring the Health Care Safety Net, Book 1: A Data Book for Metropolitan Areas, Rockville, MD: Agency for Healthcare Research and Quality. Publication No. 03-0025, p. 289 (2003).

Agency for Healthcare Research and Quality, Guide to Prevention Quality Indicators: Hos- pital Admission for Ambulatory Care Sensitive Conditions (Version 3.1), p. 2 (2007).

Jiang, HJ, CA Russo, and ML Barrett “Nation- wide Frequency and Costs of Potentially Pre- ventable Hospitalizations, 2006,” Agency for Healthcare Research and Quality, Statistical Brief #72:1–9, (2009).

Baker, supra, n.11. Weiss, BD, JS Blanchard, DL McGee, G Hart, B Warren, M Burgoon, and KJ Smith, “Illiteracy among Medicaid Recipients and Its Relationship to Health Care Costs,” Journal of Health Care for the Poor and Underserved 5(2):99−111 (1994); Nielsen-Bohlman, supra, n.13

Weiss, supra, n.20.

Supra, n.13.

DeWalt, DA, ND Berkman, S Sherican, KN

Lohr, and MP Pignone, “Literacy and Health Outcomes: A Systematic Review of the Lit- erature,” Journal of General Internal Medicine 19(12):1228–1239 (2004).

Berkman ND, SL Sheridan, KE Donahue, DJ Halpern, A Viera, K Crotty, A Holland, M Brasure, KN Lohr, E Harden, E Tant, I Wal- lace, and M. Viswanathan, “Health Literacy Interventions and Outcomes: An Updated Systematic Review,” Evidence Report/Tech- nology Assessment No. 199. Rockville, MD: Agency for Healthcare Research and Qual- ity, p. 226 (2011); Pignone, MP, DA DeWalt, SL Sheridan, ND Berkman, and KN Lohr, “Interventions to Improve Health Outcomes for Patients with Low Health Literacy: A Sys- tematic Review,” Journal of General Internal Medicine 20(2):185–192 (2004).

Vernon, JA, A Trujillo, S Rosenbaum, BA DeBuono Low Health Literacy: Implications for National Health Policy, p. 8, (2007).

Berkman, supra, n.24.

Foster, RS, “Estimated Financial Effects of the Patient Protection and Affordable Care Act. Centers for Medicare & Medicaid Services,” p. 3 (2010). Available at: http://www.hhs. gov/asl/testify/2011/03/t20110330e.html, accessed May 23, 2012.

Supra, n.12.

Baker, DW, “The Meaning and the Measure of

Health Literacy,” Journal of General Internal Medicine 21:878–883 (2006); Weiss, supra, n. 20; Nielsen-Bohlman, supra, n.13; Weiss, BD and R Palmer, “Relationship Between Health Care Costs and Very Low Literacy Skills in a Medically Needy and Indigent Medicaid Popu- lation,” Journal of the American Board of Fam- ily Medicine 17:144–147 (2004); Kutner, supra, n.12; Vernon, JA, A Trujillo, and WK Hughen, “Health Policy Brief: The High Economic Cost of Low Health Literacy in Missouri,” (2009). Available at: http://www.mffh.org/mm/files/ vernon.pdf, accessed on December 7, 2011

Sewell, J, “New Tools for an Old Prob- lem: Overcoming Health Literacy Barriers in Medicaid: Health Literacy Tool Kit,” The Council of State Governments (2003) availa- ble at: http://www.csg.org/knowledgecenter/ docs/ToolKit03HealthLiteracy.pdf, accessed December 7, 2011.

Lurie, N, LT Martin, R Ruder, JJ Escarce, B Ghosh-Dastidar, D Sherman, CE Bird, and A Freemont, “Estimating and Mapping Health Literacy in the State of Missouri,” RAND Health, p. 5, 6 (2009) available at: http://www. rand.org/content/dam/rand/pubs/working_ papers/2010/RAND_WR735.pdf, accessed December 7, 2011; Vernon, supra, n. 29.

Vernon, supra, n. 29.

Armbrecht ES, Ambulatory Care Sensitive

Conditions: Analysis of Preventable Hospi- talizations in Missouri, 2002-2009, [49], Mis- souri Hospital Association (2010).

Nielsen-Bohlman, supra, n.13.

Lurie, supra, n.31.

Missouri Department of Health and Senior

Services, Missouri Information for Commu- nity Assessment database (2010). Available at: http://www.dhss.mo.gov/MICA, accessed August 8, 2010.

Barker, MR, Missouri Medicaid Basics: 2010, Missouri Foundation for Health, p. 11 (2010). Available at: http://www.mffh.org/mm/files/ MedicaidBasics2010.pdf, accessed Decem- ber 7, 2011.

Gazmararian, JA, JW Curran, RM Parker, JM Bernhardt, and BA DeBuono, “Public Health Literacy in American: An Ethical Imperative,” American Journal of Preventative Medicine 28(3):317–322 (2005).

Baker, supra, n. 29.

McLeroy, KR, D Bibeau, A Steckler, and

K Glanz, “An Ecological Perspective on Health Promotion Programs,” Health Educa- tion Quarterly 15(4):351–377 (1988).

Freedman, DA, KD Bess, HA Tucker, DL Boyd, AM Tuchman, and KA Wallston, “Pub- lic Health Literacy Defined,” American Jour- nal of Preventive Medicine 36(5): 446–451 (2009).

Bernet, PM, “Local Public Health Agency Funding: Money Begets Money,” Jour- nal of Public Health Management Practice 13(2):188–193 (2007).

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Published

2014-06-12

Issue

Vol. 41 No. 1: Summer 2014

Section

Articles