AB1401 HEALTH LITERACY AND OUTCOMES IN PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY

Abstract

BackgroundHealth literacy is the ability to read and gain an understanding of health-related information, and make treatment and behavior choices accordingly. Poor health literacy is a main driver of health disparities in chronic medical conditions. Little is known about literacy in orthopedic surgery patients, which may be critical for post-surgical recovery.ObjectivesThis study assessed health literacy in patients undergoing total knee arthroplasty (TKA) and its association with individual and community demographics, surgical length of stay (LOS), and discharge disposition.MethodsThe study population consisted of TKA patients at a single urban orthopedic specialty hospital from 2018-2021 who completed the health literacy screen. Health literacy, patient demographics and clinical variables were extracted from a data warehouse. Patient health literacy was defined by a validated single question tool (Morris et al. 2006) administered pre-operatively: “How often do you have someone like a family member, friend, hospital or clinic worker or caregiver help you read health plan materials, such as written information about your health or care you are offered?”. Answers were “Always”, “Often”, “Sometimes”, “Occasionally” or “Never”. “Always”, “Often”, or “Sometimes” answers reflect low health literacy and “Occasionally” or “Never” reflect adequate health literacy. Census-tract level measures of community poverty and education were obtained from the 2020 American Community Survey 5-year estimates. Variable comparisons were analyzed by χ2 and one-way analysis of variance (ANOVA), with p <0.05 considered statistically significant.Results7,875 TKA patients were included. 81.3% had adequate health literacy and 18.7% had poor health literacy (Table 1). Poor health literacy patients were older (71 vs 69, p<0.0001) and spoke a non-English preferred language (7.2% vs 1.9%, p<0.0001). These patients had more comorbidities (Charlson score 2+, 92.1% vs 11.5%, p=0.001), longer LOS (hours, 58 vs 56, p<0.001), and were less often discharged to home (84.3% vs 87.8%, p=0.002). Multiple linear regression analysis using backwards elimination showed that LOS was associated with sex, comorbidity and discharge disposition, factors themselves also shown to be linked with health literacy. There were no differences in health literacy by ethnicity, insurance, community poverty or education levels.ConclusionWe found that patients in our population with low health literacy were older, non-English speaking, of Asian/other race, had higher comorbidity scores and a lower proportion of home discharges than those with adequate health literacy. Thus health literacy screening can identify patient groups for whom interventions during the pre-surgical process can be targeted. Based on results, further study can examine whether tools to support health literacy may lead to impact on important measures such as LOS and discharge disposition in orthopedic surgery patients.Reference[1]Morris, N.S., MacLean, C.D., Chew, L.D. et al. The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract 7, 21 (2006). Health services research, 45(4), 1105–1120.Table 1.Significant characteristics of patient population by health literacy levelsVariable“Never”, “Occasionally” (Adequate health literacy) (n=6400)“Often”, “Sometimes”, “Always” (Low health literacy) (n=1475)p-valueAge, years (median [IQR])71.1 (9.6)74.8 (9.3)<0.0001Sex, female %3900 (60.9)900 (61)0.98Race, %<0.001White5211 (81.4)1201 (81.4)Black/African American540 (8.4)4 (3.3)Asian/Other649 (7.4)11 (9) Charlson comorbidity index0.00104220 (65.9)899 (60.9)11447 (22.6)386 (26.2)2+733 (11.5)1358 (92.1)Preferred language, %<0.0001English6278 (98.1)1368 (92.7)Spanish44 (0.7)27 (1.8)Other78 (1.2)80 (5.4)Surgical LOS, hours (median [IQR])56 [49, 79]58 [51, 81]<0.001Discharge disposition, %0.002Home687 (10.7)161 (10.9)Home with physical therapy4935 (77.1)1082 (73.4)Skilled nursing facility/Other778 (12.1)232 (15.7)Acknowledgements:NIL.Disclosure of InterestsNone Declared.