Impact of Language Barriers on Stroke Care and Outcomes

Shah, Baiju R.; Khan, Nadia; O’Donnell, Martin J.; Kapral, Moira K.

doi:10.1161/strokeaha.114.007929

Cited by 27 publications

(23 citation statements)

References 15 publications

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“…A retrospective single-center study showed that language discordance was not associated with acute stroke misdiagnosis among patients treated with IVT [19]. Another study reported reduced mortality in patients with language barriers [13]. The possible explanations for reduced mortality, however, were likely due to inclusion of patients with TIA and family desire for aggressive intervention over quality of life [13,20].…”

Section: Discussionmentioning

confidence: 99%

“…Rostanski et al investigated the language discordance between patients and physicians and found no effect of language discordance on door-to-imaging (DTI) time and door-to-needle (DTN) time [13]. Luan et al analyzed single center data of 3894 AIS patients and found no significant difference in IVT rate between English and non-English-preferring patients [14].…”

Section: Introductionmentioning

confidence: 99%

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Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke

et al. 2020

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Background Language barriers were reported to affect timely access to health care and outcome. The aim of this study was to investigate the effect of language disparity on quality benchmarks of acute ischemic stroke therapy. Methods Consecutive patients with acute ischemic stroke at the University of California Irvine Medical Center from 2013 to 2016 were studied. Patients were categorized into 3 groups according to their preferred language: English, Spanish, and other languages. Quality benchmarks and outcomes of the 3 language groups were analyzed. Results Of the 928 admissions, 69.7% patients recorded English as preferred language, as compared to 17.3% Spanish and 13.0% other languages. There was no significant difference in the rate of receiving intravenous thrombolysis (24.3, 22.1 and 21.0%), last-known-well to door time, door-to-imaging time, door-to-needle time, and hospital length of stay among the 3 language groups. In univariate analysis, the other languages group had lower chance of favorable outcomes than the English-speaking group (26.3% vs 40.4, p < 0.05) while the Spanish-speaking group had lower mortality rate than English-speaking group (3.1% vs 7.7%, p = 0.05). After adjusting for age and initial NIHSS scores, multivariate regression models showed no significant difference in favorable outcomes and mortality between different language groups. Conclusion We demonstrate no significant difference in quality benchmarks and outcome of acute ischemic stroke among 3 different language groups. Our results suggest that limited English proficiency is not a significant barrier for time-sensitive stroke care at Comprehensive Stroke Center.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke

et al. 2020

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“…Our study focused on those patients who were discharged from a rehabilitation unit after acute ischemic stroke and differs from some earlier studies that examined patients in stroke units. 11,[14][15][16][17][18][19][20] Thus, our study had a selection bias, usually eliminating those patients with early mortality and AlphaFIM scores >80 and <40 (criteria for admission to rehabilitation after 2014). Our study was more inclusive of more independent variables than many earlier studies with respect to discharge destination from rehabilitation after acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke

Saab

Glass-Kaastra

Young

2019

Can. J. Neurol. Sci.

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ABSTRACT:Background: We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. Methods: A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. Results: Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. Conclusions: Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.

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“…8 Studies from Canada have demonstrated that among hospitalized stroke patients, language barriers are associated with increased lengths of stay and decreased inpatient mortality. 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.…”

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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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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Impact of Language Barriers on Stroke Care and Outcomes

Cited by 27 publications

References 15 publications

Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke

Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke

Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke

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

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