Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors

Hines, Anika L; Andrews, Roxanne M; Moy, Ernest; Barrett, Marguerite L; Coffey, Rosanna M.

doi:10.3390/ijerph111213017

Cited by 39 publications

(32 citation statements)

References 26 publications

(33 reference statements)

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“…However, the proportion of SMs with door-to-needle time #60 minutes did not differ between language concordant and discordant groups (8.4% [10] vs 2.5% [2], p 5 0.13, 2-tailed Fisher exact test).…”

Section: Resultsmentioning

confidence: 99%

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Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics

et al. 2016

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Background: Acute stroke is a time-sensitive condition in which rapid diagnosis must be made in order for thrombolytic treatment to be administered. A certain proportion of patients who receive thrombolysis will be found on further evaluation to have a diagnosis other than stroke, so-called "stroke mimics." Little is known about the role of language discordance in the emergency department diagnosis of acute ischemic stroke. Methods: This is a retrospective analysis of all acute ischemic stroke patients who received IV tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2015. Baseline characteristics, patient language, and final diagnosis were compared between encounters in which the treating neurologist and patient spoke the same language (concordant cases) and encounters in which they did not (discordant cases). Results: A total of 350 patients received IV tPA during the study period. English was the primary language for 52.6%, Spanish for 44.9%, and other languages for 2.6%; 60.3% of cases were classified as language concordant and 39.7% as discordant. We found no significant difference in the proportion of stroke mimics in the language concordant compared to discordant groups (16.6% vs 9.4%, p 5 0.06). Similarly, the proportion of stroke mimics did not differ between English-and Spanish-speaking patients (15.8% vs 11.5%, p 5 0.27). Conclusions: Language discordance was not associated with acute stroke misdiagnosis among patients treated with IV tPA. Prospective evaluation of communication during acute stroke encounters is needed to gain clarity on the role of language discordance in acute stroke misdiagnosis. Neurol Clin Pract 2016;6:389-396 L anguage discordance occurs when a patient and treating physician do not have proficiency in the same language and has been associated with decreased quality of acute care.1-3 However, little is known about the role of language discordance in the emergency department (ED) diagnosis of acute ischemic stroke (AIS).

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Section: Resultsmentioning

confidence: 99%

“…1,9 Work from California using administrative claims data found lower risk-adjusted inpatient mortality for Spanish-speaking stroke patients. 10 These studies did not capture language discordance or comment on the use of interpreters. We previously showed that language discordance did not affect time to thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics

et al. 2016

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“…Language discordance can negatively impact access to healthcare services, quality of healthcare services, and patient outcomes [14,15]. Previous studies have shown that residents who live in minority language situations face barriers when accessing healthcare services [16,17], have longer emergency department visits and hospitals stays [18,19], have higher rates of hospital admissions and re-admissions [20][21][22], and experience more harmful events in hospitals [23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents

et al. 2020

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Background Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. Methods We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents’ primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. Results The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57–0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81–1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53–0.94). Resident-facility language discordance did not significantly affect hospitalizations. Conclusions Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.

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“…The majority of previous studies have considered the relationship between a patient's linguistic group and specific health-related outcomes. For instance, studies have shown that linguistic groups who live in minority language situations face barriers when accessing healthcare services [7,8], have longer emergency department visits and hospitals stays [9,10], receive lower quality discharge documentation and discharge instructions [11,12], have higher rates of hospital admissions and re-admissions [13,14], and experience more harmful events in hospitals [15][16][17][18]. However, due to limitations regarding inaccurate measurement of patients' primary language and inadequate adjustment of confounding variables, it is not known whether the differences in these studies are due to language barriers, or to systematic differences in patient characteristics (e.g., socioeconomic status) and/or health status across linguistic groups.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada

Reaume

Batista

Talarico³

et al. 2020

BMC Health Serv Res

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Background: Patients who live in minority language situations are generally more likely to experience poor health outcomes, including harmful events. The delivery of healthcare services in a language-concordant environment has been shown to mitigate the risk of poor health outcomes related to chronic disease management in primary care. However, data assessing the impact of language-concordance on the risk of in-hospital harm are lacking. We conducted a population-based study to determine whether admission to a language-discordant hospital is a risk factor for in-hospital harm.Methods: We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2007 to 2015) who were admitted to a hospital in Eastern or North-Eastern Ontario, Canada. Patient language (obtained from home care assessments) was coded as English (Anglophone group), French (Francophone group), or other (Allophone group); hospital language (English or bilingual) was obtained using language designation status according to the French Language Services Act. We identified in-hospital harmful events using the Hospital Harm Indicator developed by the Canadian Institute for Health Information.Results: The proportion of hospitalizations with at least 1 harmful event was greater for Allophones (7.63%) than for Anglophones (6.29%, p < 0.001) and Francophones (6.15%, p < 0.001). Overall, Allophones admitted to hospitals required by law to provide services in both French and English (bilingual hospitals) had the highest rate of harm (9.16%), while Francophones admitted to these same hospitals had the lowest rate of harm (5.93%). In the unadjusted analysis, Francophones were less likely to experience harm in bilingual hospitals than in hospitals that were not required by law to provide services in French (English-speaking hospitals) (RR = 0.88, p = 0.048); the opposite was true for Anglophones and Allophones, who were more likely to experience harm in bilingual hospitals (RR = 1.17, p < 0.001 and RR = 1.41, p < 0.001, respectively). The risk of harm was not significant in the adjusted analysis.(Continued on next page)

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Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors

Cited by 39 publications

References 26 publications

Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics

Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents

The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada

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