Session VIII - General Interest

Sat., 10/12/13 Topics of General Interest, PAPER #93, 1:22 pm OTA 2013

Health Literacy in an Orthopaedic Trauma Population: Improving Patient Comprehension Reduces ReadmissionRates

Rishin J. Kadakia, BSc; James M. Tsahakis, BA; Neil M. Issar, BSc; Harrison F. Kay, BSc;
Kristin R. Archer, PhD, DPT; Hassan R. Mir, MD;
Vanderbilt University Medical Center, Nashville, Tennessee, USA

Background/Purpose: Research has demonstrated that surgical patients often have problems comprehending and/or identifying their discharge instructions, medications, and the specifics of their diagnoses. Patients with lower educational backgrounds have worse comprehension than those with higher educational backgrounds. It is reasonable to assume that lack of comprehension among orthopaedic trauma patients may have a deleterious effect on postoperative complication rates leading to unnecessary hospital readmissions. This study sought to determine if an educational tool administered at discharge designed to improve patient comprehension reduced the rate of unplanned readmissions secondary to postoperative complications.

Methods: Over an 8-month period, orthopaedic trauma patients at a Level I trauma center were administered a questionnaire during their first postoperative clinic visit prior to being seen by a physician. The questionnaire included questions regarding the bone fractured, the type of implanted fixation, weight-bearing status, expected recovery time, and deep venous thrombosis (DVT) prophylaxis. All patients received verbal and written instructions outlining this information at hospital discharge. During the second half of the study, patients received an intervention consisting of an informational sheet with both text and pictorial representations at discharge that reinforced the aforementioned information. Patients with minimum 3-month follow-up were included to evaluate for hospital readmission secondary to surgical site infection, hardware failure, or DVT. Statistical analysis between the two patient populations—pre- and post-intervention—was conducted using Student t tests and χ2 tests comparing demographic variables, performance on comprehension questionnaire, and hospital readmission rates.

Results: 299 eligible questionnaires were collected. 146 patients were given the standard discharge instructions (control group), while 153 patients were also administered the additional information sheet (intervention group). Previous work demonstrated that the intervention group had higher comprehension as indicated by their mean score on the questionnaire comprehension section (P = 0.009). Of the original 299 patients, 206 had minimum 3-month follow-up or suffered a postoperative complication (control group = 100, intervention group = 106). There was a 19% readmission rate secondary to postoperative complications in the pre-intervention group (N = 19/100), and a 9.4% readmission rate secondary to postoperative complications in the post-intervention group (N = 10/106). The readmission rate secondary to postoperative complication was statistically significantly lower in the post-intervention group (19.0% vs 9.4%, P = 0.048)

Conclusion: The use of an information sheet with text and pictorial representations to explain discharge instructions has been shown to improve patient comprehension. Furthermore, hospital readmission rates secondary to postoperative complication rates were decreased among patients who received the additional intervention.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.