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

Reaume, Michael; Batista, Ricardo; Talarico, Robert; Rhodes, Emily; Guérin, Eva; Carson, Sarah; Prud’homme, Denis; Tanuseputro, Peter

doi:10.1186/s12913-020-05213-6

Cited by 13 publications

(12 citation statements)

References 39 publications

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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].…”

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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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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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“…We are aware of 2 studies conducted in the acute care setting, with 1 showing that Francophones residing in Ontario were less likely to experience harm when they were treated in hospitals that were required by law to provide services French. 20,21 We sought to compare the risk of adverse, hospital-related outcomes among frail patients living in Ontario, Canada, after stratifying by patient language and patient-physician language concordance or discordance. We hypothesized that patients receiving language-concordant care would have better outcomes than those receiving language-discordant care.…”

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Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada

Seale

Reaume

Batista

et al. 2022

CMAJ

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Background: When patients and physicians speak the same language, it may improve the quality and safety of care delivered. We sought to determine whether patient-physician language concordance is associated with inhospital and postdischarge outcomes among home care recipients who were admitted to hospital. Methods:We conducted a populationbased study of a retrospective cohort of 189 690 home care recipients who were admitted to hospital in Ontario, Canada, between 2010 and 2018. We defined patient language (obtained from home care assessments) as English (Anglophone), French (Francophone) or other (allophone). We obtained physician language from the College of Physicians and Surgeons of Ontario. We defined

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“…3 Residents who live in minority language situations face barriers when accessing health care services; 4 in some situations, the care provided to these patients has been shown to be inferior with respect to both quality and safety. For instance, patients living in minority language situations are subject to higher rates of harmful events, [5][6][7][8][9] return emergency department (ED) visits, 10,11 and re-admissions to hospital. [11][12][13][14] They also experience longer stays in hospitals, [15][16][17] even after adjusting for differences in sociodemographic characteristics and health status.…”

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The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients

et al. 2021

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Background: Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents' preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers.Methods: We used administrative databases to establish a retrospective cohort study of home care recipients (2015)(2016)(2017) in Ontario, Canada, where the predominant language is English. Residents' preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year.Results: Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P < 0.01) and hospitalizations (0.6 vs. 0.7; P < 0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P < 0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10-1.39) longer when compared with Anglophones without dementia.Conclusions: Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.

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

Cited by 13 publications

References 39 publications

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

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

Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada

The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients

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