Outcome Disparities and Resource Utilization Among Limited English Proficient Patients After Tonsillectomy

Abstract

Objective: There is evidence to suggest adverse outcomes on patients’ medical and surgical care when there is language discordance in patient-physician relationships. No studies have evaluated the impact of limited English proficiency (LEP) on complications after common surgical procedures in otolaryngology. Furthermore, no studies have evaluated how patients with LEP utilize remote resources to connect with otolaryngology providers to better triage such complications. The purpose was to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) comparing patients with LEP to those with English proficiency (EP). Patients with PTH were retrospectively evaluated to identify preceding telephone encounters, a marker of resource utilization. Methods: Demographics, English proficiency, and PTH management (surgical vs non-surgical) were evaluated in addition to PTH-associated triage telephone encounters with otolaryngology providers. Results: Of 2466 tonsillectomies, there were 141 episodes of reported hemorrhage (50 LEP vs 91 EP) in the 5 years studied. Rates were not significantly different between LEP and EP patients (4.9% vs 6.3%, P = .127). There was no statistically significant difference in rate of preceding telephone encounters between LEP and EP patients (24% vs 40%, P = .062). Of patients presenting directly to the Emergency Department without a triage telephone encounter, there was no difference in operative versus non-operative management when comparing LEP versus EP patients. However, patients presenting directly to the Emergency Department were nearly twice as likely to undergo operative intervention compared to patients with preceding telephone encounters (RR = 1.79). Conclusion: Patients with limited English proficiency are not at increased risk for developing PTH. There is equitable access to remote otolaryngologic triage care, although overall the utilization rate of this resource was low for both cohorts.

Effect of an Outbound Scheduling Team on the Timeliness of Scheduling Referrals to Pediatric Otolaryngology

“…Findings of the current study support the efficacy of and offer an actionable method for reducing those barriers and increasing access to surgical care for LOE patients. These findings build on prior research 8,9 that has sought to characterize disparities in pediatric otolaryngology by patient preferred language and suggest that disparities were present among the patient population studied. This adds to the continually growing body of research seeking to understand disparities in pediatric otolaryngology by demographic factors [4][5][6][7]19 and takes a step toward answering the call for actionable methods to address them.…”

“…3 There are many factors such as race, ethnicity, and socioeconomic status (SES) that contribute to disparities in pediatric otolaryngology care. [4][5][6][7] Language preference has been associated with disparities in access to pediatric otolaryngology surgical care 8 as well as postsurgical healthcare utlilization. 9 While this body of research has helped characterize the existence of these disparities, evidence suggests that relatively little research has been dedicated to analysis of specific interventions to address them.…”