Abstract
BackgroundThe period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes.MethodsThe Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort.DiscussionThis research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes.
Highlights
The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common
Patients with cardiovascular conditions, such as acute coronary syndromes (ACS) or acute decompensated heart failure (ADHF), are a logical choice for study, as they are frequently required to manage a complex set of medications and other self-care activities after hospital discharge
Many studies have examined the efficacy of interventions to improve care transitions and reduce hospital readmission, some tailored to a patient’s level of health literacy and social circumstances [19]
Summary
Study sample Patient enrollment for VICS began in October 2011, and is scheduled to end in October 2015, with the goal of enrolling 3,000 patients. Unplanned health care utilization, including emergency department visits and unplanned readmission, is assessed at 30 and 90 days after discharge from the index hospitalization, using a combination of participant report and internal as well as external medical record review. The models will include independent variables from eight broad categories that are hypothesized to influence post-discharge outcomes They include: a) sociodemographic factors; b) health status; c) health literacy/numeracy; d) social support; e) patient-system factors; f) patient-provider factors; g) self-management; and h) care transition quality. Completion of follow-up calls far demonstrates high levels of patient retention–88.2% at 2-3 days, 88.0% at 30 days, and 86.4% at 90 days after discharge
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