Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS)
Frank E Harrell7
Chandra Y Osborn8
Jonathan S Schildcrout7
Susan P Bell1
John F Schnelle2
Katharine M Donato3
Liana D Castel8
Russell L Rothman8
Corinne M Davis5
Kathryn M Goggins5
Eduard E Vasilevskis8
Kenneth A Wallston6
Abby G Meyers4
Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
Center for Quality Aging, Vanderbilt University, Nashville, TN, USA
Department of Sociology, Vanderbilt University, Nashville, TN, USA
Vanderbilt University School of Medicine, Nashville, TN, USA
Center for Health Services Research, Vanderbilt University, Nashville, TN, USA
School of Nursing, Vanderbilt University, Nashville, TN, USA
Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, 1215 21st Ave S, Suite 6000 Medical Center East, Nashville 37232, TN, USA
The 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.
The 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.
This 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.
Kripalani S, Jackson AT, Schnipper JL, Coleman EA: Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2007, 2(5):314-323.
Jencks SF, Williams MV, Coleman EA: Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009, 360(14):1418-1428.
Ho PM, Bryson CL, Rumsfeld JS: Medication adherence: its importance in cardiovascular outcomes. Circulation 2009, 119(23):3028-3035.
Curtis JP, Schreiner G, Wang Y, Chen J, Spertus JA, Rumsfeld JS, Brindis RG, Krumholz HM: All-cause readmission and repeat revascularization after percutaneous coronary intervention in a cohort of Medicare patients. J Am Coll Cardiol 2009, 54(10):903-907.
Pendyala LK, Torguson R, Loh JP, Kitabata H, Minha S, Badr S, Dvir D, Barbash IM, Satler LF, Pichard AD, et al.: Comparison of adverse outcomes after contemporary percutaneous coronary intervention in women versus men with acute coronary syndrome. Am J Cardiol 2013, 111(8):1092-1098.
Bakhai A, Ferrieres J, Iniguez A, Sartral M, Belger M, Schmitt C, Zeymer U, APTOR Trial Investigators: Clinical outcomes, resource use, and costs at 1 year in patients with acute coronary syndrome undergoing PCI: results from the multinational APTOR registry. J Intervent Cardiol 2012, 25(1):19-27.
Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, Normand SL, Schreiner G, Spertus JA, Vidan MT, et al.: Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2010, 3(1):97-103.
Alter DA, Ko DT, Tu JV, Stukel TA, Lee DS, Laupacis A, Chong A, Austin PC: The average lifespan of patients discharged from hospital with heart failure. J Gen Intern Med 2012, 27(9):1171-1179.
Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, Kripalani S: Risk prediction models for hospital readmission: a systematic review. JAMA 2011, 306(15):1688-1698.
Arnold SV, Chan PS, Jones PG, Decker C, Buchanan DM, Krumholz HM, Ho PM, Spertus JA, Cardiovascular Outcomes Research Consortium: Translational research investigating underlying disparities in acute myocardial infarction patients’ health status (TRIUMPH): design and rationale of a prospective multicenter registry. Circ Cardiovasc Qual Outcomes 2011, 4(4):467-476.
Lichtman JH, Lorenze NP, D’Onofrio G, Spertus JA, Lindau ST, Morgan TM, Herrin J, Bueno H, Mattera JA, Ridker PM, et al.: Variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study design. Circ Cardiovasc Qual Outcomes 2010, 3(6):684-693.
Calvillo-King L, Arnold D, Eubank KJ, Lo M, Yunyongying P, Stieglitz H, Halm EA: Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med 2013, 28(2):269-282.
Waring ME, McManus RH, Saczynski JS, Anatchkova MD, McManus DD, Devereaux RS, Goldberg RJ, Allison JJ, Kiefe CI: TRACE-CORE investigators: transitions, risks, and actions in coronary events–center for outcomes research and education (TRACE-CORE): design and rationale. Circ Cardiovasc Qual Outcomes 2012, 5(5):e44-e50.
Institute of Medicine: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
Commission on Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health. In Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.
Institute of Medicine: Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004.
Mitchell SE, Sadikova E, Jack BW, Paasche-Orlow MK: Health literacy and 30-day postdischarge hospital utilization. J Health Commun 2012, 17(Suppl 3):325-338.
Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, Newman AB, Rosano C, Rooks R, Rubin SM, et al.: Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med 2006, 21(8):806-812.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV: Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011, 155(8):520-528.
Burke RE, Kripalani S, Vasilevskis EE, Schnipper JL: Moving beyond readmission penalties: creating an ideal process to improve transitional care. J Hosp Med 2013, 8(2):102-109.
Paasche-Orlow MK, Wolf MS: The causal pathways linking health literacy to health outcomes. Am J Health Behav 2007, 31(Suppl 1):S19-S26.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG: Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009, 42(2):377-381.
Norris AE, Phillips RE, Kang HP: Evaluation of a generic brief acculturation scale in a sample of male enlisted naval personnel. Clin Nurse Spec 2008, 22(4):172-178.
Pfeiffer E: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975, 23(10):433-441.
Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E: The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000, 284(7):835-842.
Elixhauser A, Steiner C, Harris DR, Coffey RM: Comorbidity measures for use with administrative data. Med Care 1998, 36(1):8-27.
Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D: Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009, 18(7):873-880.
Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM, et al.: The vulnerable elders survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 2001, 49(12):1691-1699.
Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Applied Psychol Meas 1997, 3:385-401.
Nurss JR, Parker RM, Williams MV, Baker DW: Short test of functional health literacy in adults. Snow Camp, NC: Peppercorn Books and Press; 1998.
Chew LD, Bradley KA, Boyko EJ: Brief questions to identify patients with inadequate health literacy. Fam Med 2004, 36(8):588-594.
Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM: Measuring numeracy without a math test: development of the subjective numeracy scale. Med Decis Making 2007, 27(5):672-680.
Juster FT, Suzman R: An overview of the health and retirement survey. J Hum Resources 1995, 30(suppl):S7-S56.
Rossi AS: Social responsibility to family and community. In How healthy are we? A national study of well-being at midlife. Edited by Brim OG, Ryff CD, Kessler RC. Chicago: University of Chicago Press; 2004:550-585.
Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR, Froelicher ES, Czajkowski S, Youngblood M, Huber M, et al.: A short social support measure for patients recovering from myocardial infarction: the ENRICHD social support inventory. J Cardiopulm Rehabil 2003, 23(6):398-403.
Shea JA, Micco E, Dean LT, McMurphy S, Schwartz JS, Armstrong K: Development of a revised health care system distrust scale. J Gen Intern Med 2008, 23(6):727-732.
Norman CD, Skinner HA: eHEALS: the eHealth literacy scale. J Med Internet Res 2006, 8(4):e27.
Southern WN, Nahvi S, Arnsten JH: Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med 2012, 125(6):594-602.
Graumlich JF, Novotny NL, Aldag JC: Brief scale measuring patient preparedness for hospital discharge to home: psychometric properties. J Hosp Med 2008, 3(6):446-454.
Coleman EA, Mahoney E, Parry C: Assessing the quality of preparation for posthospital care from the patient’s perspective: the care transitions measure. Med Care 2005, 43(3):246-255.
Ende J, Kazis L, Ash A, Moskowitz MA: Measuring patients’ desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med 1989, 4(1):23-30.
Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, Balkrishnan R: Measuring patients’ trust in their primary care providers. Med Care Res Rev 2002, 59(3):293-318.
Kripalani S, Jacobson TA, Mugalla CI, Cawthon RC, Niesner KJ, Vaccarino V: Health literacy and the quality of physician-patient communication during hospitalization. J Hosp Med 2010, 5(5):269-275.
Stewart AL, Napoles-Springer A, Perez-Stable EJ, Posner SF, Bindman AB, Pinderhughes HL, Washington AE: Interpersonal processes of care in diverse populations. Milbank Q 1999, 77:305-339.
Smith MS, Wallston KA, Smith CA: The development and validation of the perceived health competence scale. Health Educ Res 1995, 10(1):51-64.
Sinclair VG, Wallston KA: The development and psychometric evaluation of the brief resilient coping scale. Assessment 2004, 11(1):94-101.
Kroenke K, Spitzer RL, Williams JB, Lowe B: The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010, 32(4):345-359.
Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK, Krumholz HM, Amin A, Weintraub WS, Lichtman J, Dawood N, et al.: Time course of depression and outcome of myocardial infarction. Arch Intern Med 2006, 166(18):2035-2043.
Centers for Disease Control and Prevention: Behavioral risk factor surveillance system. Available at http://www.cdc.gov/brfss/index.htm webcite. Accessed March 10, 2010
Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE: Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med 2011, 40(1):67-71.
Sallis R: Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med 2011, 45:473-474.
Kripalani S, Risser J, Gatti M, Jacobson TA: Development and evaluation of the adherence to refills and medications scale (ARMS) among low-literacy patients with chronic disease. Value Health 2009, 12(1):118-123.
Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, Shintani A, Sponsler KC, Harris LJ, Theobald C, et al.: Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized controlled trial. Ann Intern Med 2012, 157(1):1-10.
Marvanova M, Roumie CL, Eden SK, Cawthon C, Schnipper JL, Kripalani S: Health literacy and medication understanding among hospitalized adults. J Hosp Med 2011, 6:488-493.
EuroQol Group: EQ-5D. Available at http://www.euroqol.org/ webcite. Accessed June 20, 2013
Social security online: research, statistics, & policy analysis Available at: http://www.ssa.gov/policy/about/epidemiology.html webcite. Accessed June 20, 2013
Cox DR: Regression models and life tables (with discussion). J R Stat Soc Series B 1972, 34(2):187-220.
Harrell FE Jr: Regression Modeling Strategies With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York, NY: Springer-Verlag; 2001.
Schoenfeld D: Partial residuals for the proportional hazards regression model. Biometrika 1982, 69(1):239-241.
Bentler PM: Comparative fit indexes in structural models. Psychol Bull 1990, 107(2):238-246.
Kaul P, Ezekowitz JA, Armstrong PW, Leung BK, Savu A, Welsh RC, Quan H, Knudtson ML, McAlister FA: Incidence of heart failure and mortality after acute coronary syndromes. Am Heart J 2013, 165(3):379-385. e372