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Low Health Literacy Linked to Higher Risk of Death and More Emergency Room Visits and Hospitalizations

Electronic Newsletter, Issue 310

AHRQ News and Numbers

Screening for colorectal cancer improved among white, black, and Asian-Americans age 50 and over between 2000 and 2008. However, screening of Hispanics, who have the third-highest death rate from colorectal cancer, barely improved and the rate for American Indians and Alaska Natives rate fell. The two groups have the third- and fifth-highest colorectal cancer death rates, respectively. [Source: Agency for Healthcare Research and Quality, .]

Today's Headlines

  1. Low health literacy linked to higher risk of death and more emergency room visits and hospitalizations
  2. New content available on the U.S. Preventive Services Task Force Web site
  3. AHRQ announces new health information resources on women, children, and minorities
  4. AHRQ's Effective Health Care Program Data Points publication series available
  5. Updated AHRQ evidence report on oral diabetes medications' effectiveness and safety is available
  6. Reports on health care disparities at the State level available
  7. New guide helps TeamSTEPPS® trainers learn how to teach simulation
  8. AHRQ researchers study how community-acquired methicillin-resistant Staphylococcus aureus is managed in health care settings
  9. New "Learn & Network" Web page highlights healthy weight innovations
  10. AHRQ offers full-day HCUP data users' workshop set for May 11—registration now open
  11. AHRQ in the professional literature

1. Low Health Literacy Linked to Higher Risk of Death and More Emergency Room Visits and Hospitalizations

Low health literacy in older Americans is linked to poorer health status and a higher risk of death, according to a new evidence report. More than 75 million English-speaking adults in the United States have limited health literacy, making it difficult for them to understand and use basic health information. The report, an update of a 2004 literature review, also found an association between low health literacy in all adults, regardless of age, and more frequent use of hospital emergency rooms and inpatient care, compared with other adults. The report's authors, led by Nancy D. Berkman, Ph.D., and Stacey Sheridan, M.D., M.P.H, of AHRQ's RTI International-University of North Carolina Evidence-based Practice Center, also found a link between low health literacy and a lower likelihood of getting flu shots and of understanding medical labels and instructions and a greater likelihood of taking medicines incorrectly compared with adults with higher health literacy. They also found evidence linking poor health literacy among adult women and underuse of mammograms. The authors concluded that intensive self and/or disease management programs appear to reduce disease severity, emergency room visits and hospital admissions among patients with limited health literacy. Select to access the report, Health Literacy Interventions and Outcomes: An Update of the Literacy and Health Outcomes Systematic Review of the Literature. Select to read our press release.

2. New Content Available on the U.S. Preventive Services Task Force Web Site

  • Topic Nominations: The U.S. Preventive Services Task Force (USPSTF) has expanded its Web site with new content. Now anyone—including individuals and organizations—can nominate a topic for the USPSTF to consider for a future recommendation directly through its Web site. A nomination may suggest a new preventive service topic that has not been reviewed by the USPSTF to date or recommend reconsideration of an existing topic. These nominations are accepted at any time and are considered by the USPSTF at one of its regularly scheduled meetings in March, July, or November. Select for more information or to nominate a topic.
  • Older Adults: The USPSTF Web site now provides information on preventive services and health-related topics for older adults, as well as children and adolescents. The new content focuses on the USPSTF's Older Adults Workgroup, including its members, mission and objectives, current research, and proposed research methods (including a new draft analytic framework for "geriatric syndromes"). Select for more information about the USPSTF's work with special populations.

3. AHRQ Announces New Health Information Resources on Women, Children, and Minorities

AHRQ has available three new publications that highlight data on the quality of health care and disparities experienced by women, children and minorities in the American health care system. The publications, developed from AHRQ's 2010 National Health Quality Report and National Healthcare Disparities Report focus on national trends in health care for Americans. Selected Findings on Women's Health Care, Child and Adolescent Health Care, and Minority Health Care summaries present health measures of interest on prevailing disparities in health care delivery in priority populations, highlighting progress and opportunities for improvement.

4. AHRQ's Effective Health Care Program Data Points Publication Series Available

The DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network announces a new publication series Data Points that will be available on AHRQ's Effective Health Care Program Web site. This series will offer new information and insights on the use of health care services and interventions for the treatment, management, and diagnosis of diseases, as well as the variations and potential disparities across patient subpopulations. Reports will provide brief descriptive statistics, background information, and analytic tables on a variety of specific, focused topics related to medical diagnoses, treatments, services, and patient populations. Specific reports will present new statistics on topics such as disease incidence, prevalence, and burden of illness, as well as outcomes such as readmission, morbidity, and mortality. The publication series will generally summarize the basic demographic and geographic breakdowns with additional details available in statistical tables that can be downloaded from the Effective Health Care Program Web site. The first Data Points reports describe the incidence and prevalence of diabetic foot ulcers and some of its major complications in Medicare beneficiaries. Three reports are now available on the Effective Health Care Program Web site. We invite your comments on our new Data Points series by sending an E-mail to

5. Updated AHRQ Evidence Report on Oral Diabetes Medications' Effectiveness and Safety Is Available

AHRQ released a new evidence update affirmed that therapy using only one oral drug for diabetes lowers A1C by one point. Additional evidence suggests combinations of oral medications lower A1C by 2 points. Based on the 2007 and 2010 reports, all drugs except metformin and the new injectable glucagon-like peptide agonists (GLP-1 agonists) are associated with weight gain of between 2 to 9 pounds. The report also shows that some diabetes oral medications have other benefits, such as lowering "bad" cholesterol or helping to lower triglycerides. In addition, metformin causes some abdominal discomfort, but that side effect can be managed with other drug combinations. One class of drugs is associated with increased risk of heart failure and bone or hip fractures. Select to access the report, Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults with Type 2 Diabetes: An Update Including New Drug Classes and Two-Drug Combinations. A print copy is available by sending an E-mail to

6. Reports on Health Care Disparities at the State Level Available

AHRQ has released two reports from its Healthcare Cost and Utilization Project that provide information on approaches to using race/ethnicity data for reducing disparities in the quality of health and health care. The data is from the 2010 National Health Quality Report and National Healthcare Disparities Report. Select to access the two reports.

7. New Guide Helps TeamSTEPPS® Trainers Learn How to Teach Simulation

A new guide from AHRQ and the Department of Defense provides instruction to master trainers on using simulation-based training when teaching TeamSTEPPS®. Training Guide: Using Simulation in TeamSTEPPS Training offers strategies and tools that can improve team performance and enhance patient safety. The training course is intended as a train-the-trainer program in which key personnel become familiar with the materials and activities so that they can offer the simulation-based TeamSTEPPS® training to local health care teams. Select to download a copy of the .

8. AHRQ Researchers Study How Community-Acquired Methicillin-Resistant Staphylococcus aureus Is Managed in Health Care Settings

Findings from three new AHRQ-funded reports on community-acquired methicillin-resistant Staphylococcus aureus (MRSA)are now available. The reports result from two-year projects conducted by AHRQ's Practice-Based Research Networks in Colorado, Iowa, and North Carolina. Select below to access each report.

  • Management by Primary Care Clinicians of Patients Suspected of Having Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections—State Network of Colorado Ambulatory Practices and Partners. Researchers tested interventions for two health networks to optimize treatment for skin and soft tissue infections consistent with the community-acquired MRSA guidelines developed by the Centers for Disease Control and Prevention. They found the intervention resulted in an increase in antibiotic use and the proportion of prescribed antibiotics that covered MRSA.
  • Community-Acquired Skin Infections in the Age of Methicillin-Resistant Organisms—Iowa Research Network Practices, University of Iowa. Researchers assessed how family physicians in rural areas managed patients with skin and soft tissue infections after introducing Centers for Disease Control and Prevention guidelines. They used chart review and/or follow-up to compare infection management and antibiotic therapy in patients before and after the CDC guidelines were introduced. They found that providers were more likely to prescribe antibiotics that covered MRSA at the initial patient visit after the guidelines were implemented.
  • Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA)—Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill & Duke Clinical Research Institute. Researchers worked with nine primary care practices to improve the quality of care for individuals with skin or soft tissue infections. As a result, they developed recommendations and strategies for diagnosing and managing community-acquired MRSA in these settings. For example, researchers recommend that practices develop documentation and coding presentations; integrate templates into electronic medical records for describing skin and soft tissue infections; and hold workshops in the management of skin and soft tissue infections.

9. New "Learn & Network" Web Page Highlights Healthy Weight Innovations

AHRQ, together with the Health Resources and Services Administration (HRSA) through the Health Care Innovations Exchange, presents the new Paths to Healthy Weight page featuring innovations and tools to help communities and clinicians prevent overweight and obesity. Paths to Healthy Weight showcases a collection of healthy weight innovations, expanded to now include policy and public health innovations regarding healthy weight, podcasts, perspectives, and other resources. Visit the new page to learn about a major statewide effort to childhood obesity, and check this page in coming months for new innovations, tools, and multimedia output related to healthy weight.

10. AHRQ Offers Full-Day HCUP Data Users' Workshop Set for May 11—Registration Now Open

AHRQ's Healthcare Cost and Utilization Project (HCUP) is sponsoring a free one-day workshop on May 11 at the AHRQ Conference Center in Rockville, MD to conduct revisit analyses using HCUP State data. The instructor-led workshop is targeted at intermediate-level data users or people who are familiar with HCUP. Computers will be provided and programming examples are presented in SAS. HCUP is a family of health care databases, software tools, research publications, and support services created through a Federal-State-Industry partnership. HCUP is used for a broad range of health services research and policy issues at the national, State, and local market levels, including cost and quality of health services, medical practice patterns, access to health care, and outcomes of treatments. The workshop fills quickly so early registration is encouraged. Select to register.

11. AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.

Hwang SW, Ueng JJ, Chiu S, et al. Universal health insurance and health care access for homeless persons. Am J Public Health 2010 Aug; 100(8):1454-61. Select to access the abstract on PubMed.®

Zhang Y, Lee BY, Donohue JM. Ambulatory antibiotic use and prescription drug coverage in older adults. Arch Intern Med 2010 Aug 9; 170(15):1308-14. Select to access the abstract on PubMed.®

Du XL, Liu CC. Racial/ethnic disparities in socioeconomic status, diagnosis, treatment and survival among Medicare-insured men and women with head and neck cancer. J Health Care Poor Underserved 2010 Aug; 21(3):913-30. Select to access the abstract on PubMed.®

Mazumdar M, Banerjee S, Van Epps HL. Improved reporting of statistical design and analysis: guidelines, education, and editorial policies. Stat Meth Mol Biol 2010; 620:563-98. Select to access the abstract on PubMed.®

Glance LG, Dick AW, Osler TM, et al. The association between cost and quality in trauma: is greater spending associated with higher-quality care? Ann Surg 2010 Aug; 252(2):217-22. Select to access the abstract on PubMed.®

Castle NG, Ferguson JC. What is nursing home quality and how is it measured? Gerontologist 2010 Aug; 50(4):426-42. Select to access the abstract on PubMed.®

Contact Information

Please address comments and questions regarding the AHRQ Electronic Newsletter to Nancy Comfort at or (301) 427-1866.

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Page last reviewed March 2011
Internet Citation: Low Health Literacy Linked to Higher Risk of Death and More Emergency Room Visits and Hospitalizations. March 2011. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


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