Christopher R. Carpenter|Kimberly A. Kaphingst|Melody S. Goodman|Margaret J. Lin|Andrew T. Melson|Richard T. Griffey
Feasibility and Diagnostic Accuracy of Brief Health Literacy and Numeracy Screening Instruments in an Urban Emergency Department
Jewish Hospital|Barnes-Jewish Hospital|Washington University in St. Louis|Washington University in St. Louis|Harvard Affiliated Emergency Medicine Residency|Beth Israel Deaconess Medical Center|Saint Louis University|Jewish Hospital|Barnes-Jewish Hospital|Washington University in St. Louis
objective evaluate diagnostic accuracy five health literacy screening instruments emergency department ed patients rapid evaluation adult literacy medicinerevised realmr newest vital sign nvs single item literacy screens sils health numeracy physician gestalt secondary objective evaluate feasibility instruments measured administration time time task interruptions test administrationthis prospective observational crosssectional study convenience sampling adult patients presenting march 2011 february 2012 one urban universityaffiliated ed subjects consenting noncritically ill englishspeaking patients age 18 years without aphasia dementia mental retardation inability communicate diagnostic test characteristics realmr nvs sils health numeracy physician gestalt quantitatively assessed using short test functional health literacy adults stofhla score 22 less criterion standard limited health literacy lhla total 435 participants enrolled mean sd age 45 157 years 18 less high school education defined stofhla score 22 less prevalence lhl 239 contrast nvs realmr physician gestalt identified 648 485 35 participants lhl respectively normal nvs screen useful test exclude lhl negative likelihood ratio 004 95 confidence interval ci 001 017 abnormal none screening instruments including physician gestalt significantly increased posttest probability lhl nvs realmr require 3 5 minutes less time administer stofhla administration realmr associated fewer test interruptionsonequarter ed patients marginal inadequate health literacy among brief screening instruments evaluated normal nvs result accurately reduced probability lhl although identify twothirds ed patients high risk lhl none brief screening instruments significantly increases probability lhl abnormal