Low Caregiver Health Literacy Is Associated With Higher Pediatric Emergency Department Use and Nonurgent Visits

Abstract

Objective We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. Methods This year long cross-sectional study utilized the Newest Vital Sign to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model the outcomes: 1) prior ED visits and 2) ED visit urgency, stratified by chronic illness. Analyses were weighted by triage level. Results Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (aIRR 1.5; 95% C.I.1.2, 1.8) and increased odds of a non-urgent index ED visit (AOR 2.4; 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of non-urgent index ED visits (48% vs 22%; AOR 3.2; 1.8, 5.7). Conclusions Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for non-urgent conditions. In children without a chronic illness, low health literate caregivers had more than three times great odds of presenting for a non-urgent condition than those with adequate health literacy.

Health Literacy Affects Likelihood of Radiology Testing in the Pediatric Emergency Department

“…low health literacy or minority race) present more often for non-urgent ED visits and we did not provide adjustment based on diagnoses. 11 However we provided adjustment for a non-urgent condition by including triage level in the multivariable analysis as ESI triage levels are associated with resource utilization and would adjust for arrival of a non-urgent vs. urgent visit. 21 …”

“…11 The Children’s Hospital of Wisconsin (CHW) pediatric ED treats over 60,000 pediatric patients per year serving an urban, suburban, and referral patient population. Trained research assistants (RAs) recruited a random sample of English or Spanish speaking caregivers ≥ 18 years of age of children ≤ 12 years of age from all patients presenting during predefined daytime, evening, and weekend shifts.…”

“…The score was dichotomized into low (0–4 correct) or adequate health literacy (5–6 correct) as used by prior studies of health literacy in the pediatric ED. 11,18 Caregivers self-identified race which was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, and other in analysis. Those that chose more than one race were identified in as black, white, or Hispanic for analysis.…”

“…10 Within the pediatric ED, over 50% of caregivers possess low health literacy. 11 Low health literacy is more common in caregivers of minority race and is found to affect health disparities independently of race, low educational attainment, and low socioeconomic status. 12 Caregivers with low health literacy have poor understanding of illness, which leads to care-seeking for non-urgent conditions.…”

“…12 Caregivers with low health literacy have poor understanding of illness, which leads to care-seeking for non-urgent conditions. 11 Worse expressive communication found in low health literate caregivers leads to an incomplete medical history and disengagement in medical decision-making, 10,13–15 which providers need for an accurate assessment and recommendation of resource utilization. Limitations of these health literacy skills in an ED environment may influence providers’ decision-making process in obtaining a radiologic study.…”