Influence of language barriers on outcomes of hospital care for general medicine inpatients

Abstract

BACKGROUND: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency. OBJECTIVE: To examine whether patients' primary language influences hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30‐day readmission or 30‐day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non‐English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non‐English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0‐1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2‐2.3 and OR, 1.5; 95% CI, 1.0‐2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non‐English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post‐hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.

Patterns of Interpreter Use for Hospitalized Patients with Limited English Proficiency

“…We postulate that failure to communicate adequately with patients with LEP may contribute to medical errors during hospitalization 21 , as well as higher rates of re-hospitalization compared with English-speaking patients. 22 While cost is clearly a barrier to achieving adequate interpreter access 4 , such costs may be offset by avoiding significant errors and unnecessary re-hospitalizations.…”

Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes

“…Five prior studies have analyzed the outcomes of LEP hospitalized patients compared to English speakers, but only two of these studies examined the impact of interpreter use with conflicting results. [12][13][14][15][16] The first study found no difference in LOS and 3-month ED utilization nor readmission rates with data from a large urban public hospital. 14 The second study found that the use of professional interpretation at admission or both admission and discharge was associated with an increased LOS and decreased readmission rates compared to those LEP patients without professional interpretation.…”

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

“…3 Previous studies have demonstrated that patients with LEP experience health disparities including higher error and readmission rates in the hospital setting and less health education and healthcare utilization in the ambulatory setting. [4][5][6][7][8] Language barriers between the clinician and patient can disrupt effective communication and comprehension of healthcare information and place this growing population of vulnerable patients at heightened risk of inadequate informed consent. 7,9,10 Our prior systematic review found that professional interpreters improve patient-clinician communication for patients with LEP.…”