Associations between Health Literacy and End-of-Life Care Intensity among Medicare Beneficiaries [electronic resource].

9781392449974

Ann Arbor : ProQuest Dissertations & Theses, 2020.

1 online resource (25 p.)

Access is available to the Yale community.

Background: While literature suggested that patients with inadequate health literacy tended to have more healthcare utilization, the impact of limited health literacy on end of life (EOL) care intensity remains unknown.Objectives: This study examined the association between health literacy and end-of-life (EOL) care intensity among Medicare beneficiaries in the US.Methods: We analyzed claims data from Medicare beneficiaries who died in July–December, 2011. We obtained zip code-level health literacy scores from the 2010–2011 UNC Health Literacy Data Map, and determined low health literacy as health literacy estimates of 225 or lower and high health literacy as health literacy estimates above 225. Our outcome measures—aggressive EOL care—include repeated hospitalization within the last 30 days, no hospice enrollment within the last six months, and hospital death. We conducted 3-level hierarchical generalized linear models to determine the association between health literacy and aggressive EOL care, clustering at HRR and state levels.Results: After linking claims data with health literacy scores at zip code level, we had 650,275 individuals assigned with health literacy scores (9,967 individuals missing health literacy scores): 98.0% were in high health literacy areas (above basic) and 2.0% were in low health literacy areas (below basic). Compared to decedents in the areas with high health literacy level, those in the areas low health literacy level had more intensive EOL care [AOR 1.36 (95% CI: 1.34, 1.37)] with higher rates of repeated hospitalization [AOR 1.15 (95% CI: 1.09, 1.21)], hospital death [AOR 1.26 (95% CI: 1.19, 1.34)] and lower rates of hospice use [AOR 1.4 (95% CI: 1.32, 1.48)) for no hospice use]. The results were statistically significant with all p-values < .001.Conclusion: Low health literacy is associated with aggressive EOL care intensity.Efforts to improve health literacy and facilitate patient-provider communication could reduce EOL care intensity.

Dissertations & Theses @ Yale University.

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English

January 17, 2020

Thesis (M.P.H.)--Yale University, 2020.

Yale University. School of Public Health.