Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study

Abstract

BACKGROUND:Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. OBJECTIVE: Estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates vary at hospitals with a high versus low proportion of LEP patients. DESIGN: Retrospective cohort study of California's 2017 inpatient and ED administrative data PARTICIPANTS: Community-dwelling individuals ≥ 18 years without a primary diagnosis of pregnancy or childbirth. LEP patients had a principal language other than English. MAIN MEASURES: We used a series of linear probability models with incremental sets of covariates, including patient demographics, primary diagnosis, and Elixhauser comorbidities, to examine admission rate for visits of LEP versus EP patients. We then added an interaction covariate for high versus low LEP-serving hospital. We estimated models with and without hospital-level random effects. KEY RESULTS: These analyses included 9,641,689 ED visits; 14.7% were for LEP patients. . Observed rate of admission for all ACSC ED visits was higher for LEP than for EP patients (26.2% vs. 25.2; p value < .001). Adjusted rate of admission was not statistically significant ). For COPD, the difference was significant (36.8% [95% CI 35.0-38.6%] vs. 33.3% [95% CI 31.7-34.9%]). Difference in adjusted admission rate for LEP versus EP visits did not differ in high versus low LEP-serving hospitals. CONCLUSIONS: In adjusted analyses, LEP was not a risk factor for admission for most ACSCs. This finding was observed in both high and low LEP-serving hospitals.

Race-Based Differences in ST-Segment–Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients From the American Heart Association Get With The Guidelines–Coronary Artery Disease Registry

“…Limited English-language proficiency (a variable not captured in the GWTG-CAD registry) has been reported to contribute to worse outcomes in patients with STEMI and in other emergency conditions. 29,30 In addition, mistrust of the US health care system by non-White individuals (also not collected) may lead to delays in providing consent or participating in shared decision-making for procedures. 26,31 Large-scale registries (such as the GWTG-CAD registry) that are powered to discern differences in outcomes in process and hard outcomes (such as death) are often lacking in data elements that probe into these important race-specific barriers to equitable care.…”

Effects of Maryland’s global budget revenue model on emergency department utilization and revisits

“…We used DiD regression models to study the effects of GBR on the outcome measures. We used a generalized linear model to estimate ED visits per 1,000 population and, for the binary outcome measures, ED admissions and returns, we used a linear probability model consistent with prior research 10,29,30 31 .…”

The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

“…These hospital care studies addressed a variety of elements related to hospital care, such as end-of-life and palliative care, healthcare service delivery and patient satisfaction, interpreter impact, potentially preventable conditions, discharge instructions, length of stay, and hospital stay cost. Eight studies were conducted using data from California public hospitals or healthcare systems [50][51][52][53][54][55][56][57]. State and national datasets used in hospital care studies included the National Trauma Registry of the American College of Surgeons (NTRACS), the Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP), California State Inpatient Databases, the American Hospital Association's (AHA) Annual Survey, Hawaii's Health Information Corporation's (HHIC) inpatient database, and the Asian American Elders in New York City Study (AAENYC).…”

“…Studies exploring hospital admission and readmission had more consistent findings. Six studies found that LEP patients were more likely to be admitted upon visiting the emergency department or to be readmitted within 30 days [49,56,59,60,[68][69][70], and another study determined that interpreter usage minimized the likelihood of 30-day readmission [65].…”