Is There Inequity in Hospital Care Among Patients With Acute Coronary Syndrome Who Are Proficient and Not Proficient in English Language?

Hyun, Karice; Redfern, Julie; Woodward, Mark; Briffa, Tom; Chew, Derek P.; Ellis, Chris; French, John K.; Astley, Carolyn; Gamble, Greg; Nallaiah, Kellie; Howell, Tegwen; Lintern, Karen; Clark, Robyn; Wechkunanukul, Kannikar; Brieger, David

doi:10.1097/jcn.0000000000000342

Cited by 9 publications

(27 citation statements)

References 9 publications

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Studies reported findings from academic hospital settings and community hospitals. Eighteen of 29 studies were performed at a single center, whereas 5 studies were multicenter and 6 studies used a statewide or nationwide database (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…This review found substantial variation in the methods used to define language proficiency and LEP. Most included studies defined LEP using self-report measures that were documented in electronic medical records. Many studies used a non-English preferred language as a proxy for LEP.…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen of 29 studies 16, [18][19][20][21][22][23]25,27,[29][30][31]33,35,38,[40][41][42] were performed at a single center, whereas 5 studies 15,17,32,39,43 were multicenter and 6 studies 24,26,28,34,36,37 used a statewide or nationwide database (Table 1). Eighteen studies 16, 17, 21-23, 26, 28, 29, 31-34, 36, 38, 39, 41-43 evaluated a patient cohort that underwent surgical admission, whereas 11 studies 15,[18][19][20]24,25,27,30,35,37,40 19,22,23,26,28,29,32,33,38,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Most included studies [17][18][19][20][23][24][25][26][27][28]30,[32][33][34][35][36][37]39,40,43 defined LEP using self-report measures that were documented in electronic medical records. Many studies [15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][32] used a non-English preferred language as a proxy for LEP.…”

Section: Defining Lepmentioning

confidence: 99%

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Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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ImportanceEnglish language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities.ObjectiveTo examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes.Evidence ReviewA systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline.FindingsOf 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status.Conclusions and RelevanceIn this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Defining Lepmentioning

confidence: 99%

See 3 more Smart Citations

Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review

et al. 2022

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BACKGROUND: Limited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients. METHODS: This systematic review searched PubMed, Embase, and Web of Science from database inception through June 7, 2020, to identify research investigating clinical outcomes in patients receiving hospital-based care (in the emergency department, inpatient ward, surgical/procedural suite, or intensive care unit) that compared patients with LEP to an EP group. We assessed mortality, length of stay (LOS), readmissions/revisits, and complications. Study quality was evaluated using the Newcastle-Ottawa Scale. RESULTS: Twenty-six studies met eligibility criteria. Study settings and populations were heterogeneous. Determination of primary language varied; a majority of studies (16/26) used patient self-report directly or via hospital records. Of 16 studies examining LEP and allcause mortality, 13 found no significant association. Of 17 studies measuring LOS, 9 found no difference, 4 found longer LOS, 3 found shorter LOS, and 1 had mixed LOS results among patients with LEP. Several investigations suggested that LOS differences may be mediated at the hospital level. Nine studies evaluated inpatient readmissions. Among patients with LEP, there was evidence for increased readmissions in the setting of chronic medical conditions such as heart failure, but no evidence for increased readmissions among cohorts undergoing surgeries/procedures or with acute medical conditions. Five studies evaluated complications or harm related to a hospitalization, and no differences were found between language groups. DISCUSSION: The research community lacks a standardized definition of LEP. Most studies did not find an association between English proficiency and mortality or complications. LOS findings were mixed and may be influenced at the hospital level. Differences in readmissions by language were concentrated in chronic medical conditions. Given the paucity of studies examining LEP populations, additional research is imperative.

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