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Background: Inadequate health literacy, defined as inadequate ability to find, understand and use health information is associated with poor health outcomes and high health care costs. Children with medical complexity (CMC) have high rates of acute care utilization. Understanding parental health literacy in CMC and its relationship to acute care utilization may inform interventions designed to lower utilization.

Objective: To examine parental health literacy for CMC and determine its association with acute care utilization.

Design/Methods: In this single-site cross-sectional study, 250 parents of CMC completed a self-administered survey (response rate of 66.1%). CMC were included if they had a complex chronic condition (CCC) and were enrolled in the CMC primary care clinic or received primary care at the study site. The main predictor was parental health literacy as measured by the validated Single Item Literacy Screener (SILS). SILS measures the frequency of needing assistance when reading medical information. Table 1 lists the categorization of SILS responses in our original and post hoc analyses. Main outcomes were acute care utilization defined as annual emergency department (ED) visits, hospitalizations, and associated costs. We examined bivariate associations with the X2 test and multivariable associations with a generalized linear model with log link and time from first to last episode as offset, adjusting for demographic and clinical characteristics.

Results: About 94% of parents had adequate health literacy (Table 2). Adequate health literacy increased with the number of CCCs (p<0.01). When using the traditional categorization of SILS responses, there were no differences in acute care utilization by health literacy in the bivariate (Table 3) and adjusted analyses (Table 4). In the post-hoc adjusted analyses, parents with Low-Adequate health literacy had seven times greater annual ED costs compared to parents with High-Adequate health literacy. They also had 35% more annual hospitalizations and 64% greater hospitalization costs compared to parents with High-Adequate health literacy (Table 4).

Conclusion(s): Parents of CMC had high rates of adequate health literacy. Future studies should determine if this is common in parents of CMC or unique to our study population. We found few associations with acute care utilization. Future studies should examine if additional aspects of health literacy (e.g., listening, speaking, numeracy) not included in the SILS better predict acute care utilization.

Presented at the 2021 PAS Virtual Conference



Parental Health Literacy and Acute Care Utilization in Children with Medical Complexity

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