Health Literacy, Health Confidence, and Simulation

A Novel Approach to Patient Education to Reduce Readmissions

Abstract

Purpose/Objectives: 

The vision for this project was to create an inpatient education intervention to better prepare patients with chronic medical conditions for more effective self-management after discharge using a Skills Simulation Experience and focused one-on-one structured education format in a circuit-based intervention. As an interdisciplinary intervention, the health care team presents standardized education in a circuit training presentation to allow for one-on-one interaction with health care professionals, using multiple teaching/learning strategies, to assist the participant in acquiring or reinforcing skills needed to successfully self-manage his or her conditions postdischarge.

Primary Practice Setting(s): 

West Suburban Medical Center (WSMC) is owned by Pipeline Health and is located on the west side of Chicago, IL. WSMC is a 118-year-old community-based teaching facility that has collaboration with a local Federally Qualified Health Center, providing clinic space on-site as well as clinical rotations for OB/GYN. WSMC serves 2 very diverse neighborhoods, Oak Park, IL, home of Frank Lloyd Wright and Ernest Hemingway, and the Austin neighborhood of Chicago, which ranks 11th out of the 77 Chicago communities in violent crime.

Findings/Conclusions: 

Data collected included the following:

1. Participation in Simulation Laboratory (SIM LAB) experience: During the time frame of the project, 323 patients were identified as eligible for participation in the project. Of those identified as eligible, there were 130 patients who completed the intervention (37.15%).
2. Readmission events within 30 days from index admission: The intervention period (January–December 2019) noted a readmission rate for the target population of patients with chronic obstructive pulmonary disease/congestive heart failure of 10.12% compared with a readmission rate of 21.05% for the nonparticipation group.
3. Patient self-evaluation of ability to care (pre/postintervention test): The average preintervention test score of the participants was 39.6/50, whereas the average postintervention test score increased to 50.2, a 21% increase in perceived knowledge base.
4. Patient self-evaluation of health confidence score (pre/postintervention): SIM LAB participants' average health confidence score prior to the intervention was 6.71 (under the baseline desired 7.0 or 0.95/1.00 desired outcome) and postintervention was 8.74 (significantly higher than the 7.0 baseline or 1.25/1.00 desired outcome). The net gain is noted as 2.03 points on the 10-point scale.

Implications for Case Management Practice: 

1. Patient perspective on why readmission occurred should always be explored and taken into consideration.
2. Health literacy/confidence is a key Social Determinant of Healthcare (SDoH), a greater predictor of success/failure than any other SDoH.
3. Patient-focused, interdisciplinary, multiexperience discharge teaching, using varied teaching methods, has been demonstrated to reduce readmissions and increase patient/caregiver health confidence.