Factors associated with surgical management in an underinsured, safety net population

Winton, Lisa M.; Nodora, Jesse; Martı́nez, Marı́a Elena; Hsu, Chiu Hsieh; Djenic, Brano; Bouton, Marcia E.; Aristizabal, Paula; Ferguson, Elizabeth M.; Weiss, Barry D.; Komenaka, Ian K.

doi:10.1016/j.surg.2015.08.016

Cited by 16 publications

(15 citation statements)

References 44 publications

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“…The number of studies on health literacy in surgery has significantly increased from 2002 to 2018 (Figure 2). Since the last review in 2013, studies on health literacy in surgery have expanded to surgical subspecialties ranging from general surgery (Garcia-Marcinkiewicz et al, 2014;Koster et al, 2017;Wright et al, 2018) to vascular (Tung et al, 2014) to breast (Halbach et al, 2016;Huang et al, 2018;Keim-Malpass et al, 2018;Komenaka et al, 2014;Mercieca-Bebber et al, 2017;Parekh et al, 2017;Schmidt et al, 2016;Tang et al, 2017;Winton et al, 2016), and urology (Izard et al, 2014;Scarpato et al, 2016;Turkoglu et al, 2019). Several health literacy instruments have also been developed that are unique for surgical subspecialties (Gibbs et al, 2016;Gordon & Wolf, 2009;Kazley et al, 2014;Wallace et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Health literacy was assessed to varying degrees in surgical subspecialties (Figure 3): 13 were in abdominal transplant (Dageforde et al, 2015;Dageforde et al, 2014;Escobedo & Weismuller, 2013;Gordon & Wolf, 2009;Grubbs et al, 2009;Jones et al, 2016;Kazley et al, 2015;Lambert et al, 2015;Miller-Matero et al, 2015;Patzer et al, 2016;Serper et al, 2015;Taylor et al, 2016;Weng et al, 2013), nine in breast surgery (Halbach et al, 2016;Huang et al, 2018;Keim-Malpass et al, 2018;Komenaka et al, 2014;Mercieca-Bebber et al, 2017;Parekh et al, 2017;Schmidt et al, 2016;Tang et al, 2017;Winton et al, 2016), six in hand surgery (Alokozai et al, 2017;Menendez, Chen, et al, 2015;Menendez et al, 2016;Menendez et al, 2017;Parrish et al, 2016;Roh et al, 2018), five in general surgery (Chew, Bradley, Flum, et al, 2004;Garcia-Marcinkiewicz et al, 2014;Halleberg Nyman et al, 2018;Koster et al, 2017;Wright et al, 2018), three in orthopedics (Choi, 2011;Chu & Tseng, 2013;Rosenbaum et al, 2015), three in urology (Izard et al, 2014;…”

Section: Health Literacy Has Been Assessed In Limited Surgical Populamentioning

confidence: 99%

“…These surgery specialties also show preferences to which instruments were predominantly used to assess health literacy in their patient population. For example, hand surgery has almost exclusively used the NVS (Alokozai et al, 2017;Menendez et al, 2016;Menendez et al, 2017;Parrish et al, 2016;Roh et al, 2018), whereas abdominal transplant (Dageforde et al, 2015;Dageforde et al, 2014;Escobedo & Weismuller, 2013;Gordon & Wolf, 2009;Grubbs et al, 2009;Jones et al, 2016;Kazley et al, 2015;Lambert et al, 2015;Miller-Matero et al, 2015;Patzer et al, 2016;Serper et al, 2015;Taylor et al, 2016;Weng et al, 2013) and breast surgery (Halbach et al, 2016;Huang et al, 2018;Keim-Malpass et al, 2018;Komenaka et al, 2014;Koster et al, 2017;Mercieca-Bebber et al, 2017;Parekh et al, 2017;Schmidt et al, 2016;Tang et al, 2017;Winton et al, 2016) used several instruments to assess health literacy (Figure 4).…”

Section: Health Literacy Has Been Assessed In Limited Surgical Populamentioning

confidence: 99%

“…Health literacy has been assessed in all three phases of operative care (preoperative, perioperative, and postoperative), and no consensus exists as to the optimal timing of assessment with regard to an operation. Twenty-eight studies evaluated health literacy only in the preoperative settings, and 19 studies evaluated it only in the postoperative setting (Beitler et al, 2010;Cajita et al, 2017;Dageforde et al, 2015;Dageforde et al, 2014;Gordon & Wolf, 2009;Halbach et al, 2016;Halleberg Nyman et al, 2018;Izard et al, 2014;Khan et al, 2018;Mercieca-Bebber et al, 2017;Parekh et al, 2017;Patzer et al, 2016;Schmidt et al, 2016;Serper et al, 2015;Tang et al, 2017;Tung et al, 2014;Turkoglu et al, 2019;Weng et al, 2013;Winton et al, 2016). Three studies included assessments of patients in both pre-and postoperative periods (Escobedo & Weismuller, 2013;Kazley et al, 2015;Kazley et al, 2014), and one study did not state in which perioperative setting health literacy was evaluated (Keim-Malpass et al, 2018).…”

Section: Health Literacy Has Been Assessed In Limited Surgical Populamentioning

confidence: 99%

“…Preoperatively, health literacy has been shown to affect whether patients undergo surgical procedures. In breast surgery, for example, low health literacy has been associated with lower reconstruction rates in patients (Winton et al, 2016). Kazley et al (2015) has also demonstrated that level of health literacy is a predictor for whether a patient is listed for kidney transplantation.…”

Section: Association Of Health Literacy With Surgical Outcomesmentioning

confidence: 99%

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Health Literacy in Surgery

Chang¹,

Baker²,

Marques³

et al. 2020

HLRP: Health Literacy Research and Practice

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Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%-50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45-e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery. METHODS Systematic Search Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Liberati et al., 2009), a comprehensive search of the National Library of Medicine's PubMed database, Embase, Scopus database, Proquest, PsychInfo, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed through May 31, 2018. Through partnerships with Library Services at the University of Alabama Birmingham, keywords and medical subject heading (MESH) terms used in the search included "health literacy, " "surgical, " "post-operative, " and "surgery. " The entire search string for each database along with the number of screened abstracts can be found in Table A. Two authors (S.J.B. and I.C.D.S M.) who are experienced researchers independently evaluated abstracts of the 673 articles obt...

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Section: Discussionmentioning

confidence: 99%

Section: Health Literacy Has Been Assessed In Limited Surgical Populamentioning

confidence: 99%

Section: Health Literacy Has Been Assessed In Limited Surgical Populamentioning

confidence: 99%

Section: Health Literacy Has Been Assessed In Limited Surgical Populamentioning

confidence: 99%

Section: Association Of Health Literacy With Surgical Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Health Literacy in Surgery

Chang¹,

Baker²,

Marques³

et al. 2020

HLRP: Health Literacy Research and Practice

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Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

Wong,

Victorino,

Miraflor

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesTextbook oncologic outcome (TOO) is a benchmark for high‐quality surgical cancer care but has not been studied at safety‐net hospitals (SNH). The study sought to understand how SNH burden affects TOO achievement in colorectal cancer.MethodsThe National Cancer Database was queried for colorectal cancer patients who underwent resection for stage I‐III plus stage IV with liver‐only metastases (2010–2019). TOO was defined as R0 resection, AJCC‐compliant lymphadenectomy (>12 nodes), no prolonged LOS, no 30‐day mortality/readmission, and receipt of stage‐appropriate adjuvant chemotherapy.ResultsOf 487,195 patients, 66.7% achieved TOO. Lower achievement was explained by adequate lymphadenectomy (87.3%), non‐prolonged LOS (76.3%), and receipt of adjuvant chemotherapy in stage III (60.3%) and IV (54.1%). Treatment at high burden hospitals (HBH, >10% Medicaid/uninsured) was a predictor of non‐TOO (Stage I/II: OR 0.83, III: OR 0.86, IV: OR 0.83; all p < 0.001). Achieving TOO was associated with decreased mortality (Stage I/II: HR 0.49, III: HR 0.48, IV: HR 0.57; all p < 0.001), and HBH treatment was a predictor of mortality (Stage I/II: HR 1.09, III: HR 1.05, IV: HR 1.07; all p < 0.05).ConclusionsTreatment at higher SNH burden hospitals was associated with less frequent TOO achievement and increased mortality. Quality improvement targets include receipt of adjuvant chemotherapy and avoidance of prolonged LOS.

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Factors Associated With Inadequate Health Literacy: An Academic Otolaryngology Clinic Population Study

Hearn,

Sciscent,

King

et al. 2024

OTO Open

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ObjectiveTo characterize the prevalence of inadequate health literacy among otolaryngology patients and assess the association of individual patient factors with inadequate health literacy.Study DesignCross‐sectional study.SettingTertiary academic medical center otolaryngology clinic.MethodsAdult patients presenting to the clinic were recruited from March to June 2022. Participants completed a validated health literacy questionnaire in the waiting room. Data on age, sex, race, insurance, county of residence, and language were extracted from the electronic medical record, linked to the survey responses, and deidentified for analysis. Logistic regression analyses assessed the association between inadequate health literacy and patient factors.ResultsOf 374 participants, the mean age was 54.8 years (SD = 17.8) and most were white (79%) and native English speakers (95%). The median health literacy score was 14.5 (Q1‐Q3: 12.0‐15.0) and 43 participants (12%) had inadequate health literacy. Bivariate analysis showed the odds of inadequate health literacy were 2.5 times greater for those with public insurance (95% confidence interval [CI]: 1.24‐5.20, P = .011), 3.5 times greater for males (95% CI: 1.75‐6.92, P < .001), and significantly different among race groups (P = .003). When all factors were evaluated simultaneously with multivariable regression, only sex (P < .001) and race (P = .005) remained significant predictors of inadequate health literacy. There were no significant associations between health literacy and age or rurality.ConclusionInadequate health literacy was associated with sex and race, but not with age or rurality. 12% of patients had inadequate health literacy, which may perpetuate disparities in care and necessitate interventions to improve care delivery in otolaryngology.

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Factors associated with surgical management in an underinsured, safety net population

Cited by 16 publications

References 44 publications

Health Literacy in Surgery

Health Literacy in Surgery

Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

Factors Associated With Inadequate Health Literacy: An Academic Otolaryngology Clinic Population Study

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