Association of Health Literacy and Ambulatory Care–Sensitive Condition Emergency Department Visits

ED wait times are increasing, leading to patient and provider frustration. Avoidable ED visits may contribute to crowding, which may be due to some patients' use of the ED for conditions better served in ambulatory care, either due to lack of health literacy, support in navigating healthcare systems or adequate access to ambulatory care. In this study, we examined if patients with inadequate or marginal health literacy have a higher association with their visit being diagnosed with an ambulatory care sensitive condition (ACSC) compared to patients with adequate health literacy.

Adult patients that spoke English and/or Spanish who arrived at LA Gen ED were surveyed by trained research assistants from June 2024 - August 2025, in a cross-sectional survey administered via tablet. Patients were excluded if they were in isolation rooms, in custody, staff advised against approaching, or critically ill. Health literacy was measured with the Chew 3 item Health Literacy Screen as adequate, marginal or inadequate. ACSC was defined using the Billings criteria update to ICD-10 codes. We built logistical regression models to account for potential confounding.

The study population was mostly Hispanic/Latino (81%) and Spanish language preference (56%). Patients with marginal or inadequate health literacy had similar odds of having an ACSC diagnosis (OR = 0.95; 95% CI: 0.81 -1.12; p >.53) to patients with adequate health literacy. The relationship was unchanged after adjusting for potential cofounders and moderators (age, language, education, housing status, insurance, sex, racial and ethnic group, having a usual source of care, self-reported health and disposition).

We found no association between health literacy and the odds of receiving an ACSC diagnosis. While health literacy may not be associated with ACSC visits, educating patients to improve treatment, management and relationships is still of importance. Further research with more modern definitions of ACSCs and health literacy may highlight important relationships.