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Raff L, Blank AG, Crespo Regalado R, Bulik-Sullivan E, Phillips L, Moore C, Galvan Miranda L, Raff E. A Quality Improvement Project to Reduce Rapid Response System Inequities for Patients with Limited English Proficiency at a Quaternary Academic Medical Center. J Gen Intern Med 2024; 39:1103-1111. [PMID: 38381243 PMCID: PMC11116344 DOI: 10.1007/s11606-024-08678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts. OBJECTIVE To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations. DESIGN Quasi-experimental pre-post design using quality improvement (QI) statistics. PARTICIPANTS All adult hospitalized non-intensive care patients with LEP who were admitted to a large academic medical center from May 2021 through March 2023 and experienced RR system activation were included in the evaluation. All patients included after May 2022 were exposed to the intervention. INTERVENTIONS Implementation of a modified RR system for LEP patients in May 2022 that included electronic dashboard monitoring of early warning scores (EWSs) based on electronic medical record data; RR nurse initiation of consults or full RR system activation; and systematic engagement of interpreters. MAIN MEASURES Process of care measures included monthly rates of RR system activation, critical response nurse consultations, and disease severity scores prior to activation. Main outcomes included average post-RR system activation length of stay, escalation of care, and in-hospital mortality. Analyses used QI statistics to identify special cause variation in pre-post control charts based on monthly data aggregates. KEY RESULTS In total, 222 patients experienced at least one RR system activation during the study period. We saw no special cause variation for process measures, or for length of hospitalization or escalation of care. There was, however, special cause variation in mortality rates with an overall pre-post decrease in average monthly mortality from 7.42% (n = 8/107) to 6.09% (n = 7/115). CONCLUSIONS In this pilot study, prioritized tracking, utilization of EWS-triggered evaluations, and interpreter integration into the RR system for LEP patients were feasible to implement and showed promise for reducing post-RR system activation mortality.
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Affiliation(s)
- Lauren Raff
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of North Carolina School of Medicine, 4008 Burnett-Womack Building, Campus Box 70, Chapel Hill, NC, 27599, USA
| | - Andrew G Blank
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA
| | - Ricardo Crespo Regalado
- University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC, 27599, USA
| | - Emily Bulik-Sullivan
- University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC, 27599, USA
| | - Lindsey Phillips
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA
| | - Carlton Moore
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA
| | - Lilia Galvan Miranda
- Department of Interpreter Services, University of North Carolina Health, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Evan Raff
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA.
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Batista R, Hsu AT, Bouchard L, Reaume M, Rhodes E, Sucha E, Guerin E, Prud'homme D, Manuel DG, Tanuseputro P. Ascertaining the Francophone population in Ontario: validating the language variable in health data. BMC Med Res Methodol 2024; 24:98. [PMID: 38678174 PMCID: PMC11055282 DOI: 10.1186/s12874-024-02220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied. This study assessed concordance between language variables from administrative health databases and language variables from the Canadian Community Health Survey (CCHS) to identify Francophones in Ontario. METHODS An Ontario combined sample of CCHS cycles from 2000 to 2012 (from participants who consented to link their data) was individually linked to three administrative databases (home care, long-term care [LTC], and mental health admissions). In total, 27,111 respondents had at least one encounter in one of the three databases. Language spoken at home (LOSH) and first official language spoken (FOLS) from CCHS were used as reference standards to assess their concordance with the language variables in administrative health databases, using the Cohen kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV). RESULTS Language variables from home care and LTC databases had the highest agreement with LOSH (kappa = 0.76 [95%CI, 0.735-0.793] and 0.75 [95%CI, 0.70-0.80], respectively) and FOLS (kappa = 0.66 for both). Sensitivity was higher with LOSH as the reference standard (75.5% [95%CI, 71.6-79.0] and 74.2% [95%CI, 67.3-80.1] for home care and LTC, respectively). With FOLS as the reference standard, the language variables in both data sources had modest sensitivity (53.1% [95%CI, 49.8-56.4] and 54.1% [95%CI, 48.3-59.7] in home care and LTC, respectively) but very high specificity (99.8% [95%CI, 99.7-99.9] and 99.6% [95%CI, 99.4-99.8]) and predictive values. The language variable from mental health admissions had poor agreement with all language variables in the CCHS. CONCLUSIONS Language variables in home care and LTC health databases were most consistent with the language often spoken at home. Studies using language variables from administrative data can use the sensitivity and specificity reported from this study to gauge the level of mis-ascertainment error and the resulting bias.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Institut du Savoir Montfort, ICES and Ottawa Hospital Research Institute, 1053 Carling Ave Box 693, 2-006 Admin Services Building, Ottawa, ON, K1Y 4E9, Canada.
| | - Amy T Hsu
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Elizabeth Bruyère Research Institute, Ottawa, ON, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Social and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Université de Moncton, Moncton, New Brunswick, Canada
| | - Douglas G Manuel
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Statistics Canada, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Twersky SE, Jefferson R, Garcia-Ortiz L, Williams E, Pina C. The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review. Healthcare (Basel) 2024; 12:364. [PMID: 38338249 PMCID: PMC10855368 DOI: 10.3390/healthcare12030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.
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Affiliation(s)
- Sylvia E. Twersky
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Rebeca Jefferson
- R. Barbara Gitenstein Library, The College of New Jersey, Ewing Township, NJ 08618, USA;
| | - Lisbet Garcia-Ortiz
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Erin Williams
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Carol Pina
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
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Chhabra N, Christian E, Seseri V, George F, Rizvanolli L. Association of Patient English Proficiency and Diagnostic Imaging Acquisition in Emergency Department Patients with Abdominal Symptoms. J Emerg Med 2023; 65:e172-e179. [PMID: 37635035 DOI: 10.1016/j.jemermed.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) are at risk for communication barriers during medical care in the United States compared with English-proficient (EP) patients. It is unknown how EP affects the utilization of advanced diagnostic imaging (ADI) in the emergency department (ED). OBJECTIVE The aim of this study was to compare the acquisition and findings of ADI in EP and LEP patients with abdominal symptoms. METHODS We conducted a retrospective analysis of adult ED patients from January 2015 to January 2016. Patients were divided into EP and LEP cohorts. Logistic regression models incorporated language proficiency, interpretation method, and demographic characteristics. We determined crude and adjusted odds ratios (ORs) for the acquisition of ADI, defined as either computed tomography or ultrasound, and the proportion with actionable findings. RESULTS In 3324 encounters (2134 EP; 1190 LEP), LEP patients were older (46.3 years vs. 43.8 years), more likely to be female (66.7% vs. 51.5%), and preferred Spanish (91.4%). ADI was obtained in 43.5% of EP and 48.1% of LEP. Adjusting for age, sex, and interpretation method, the OR was 1.09 (95% CI 0.90-1.32). There were no significant associations between interpretation type and acquisition of ADI. The proportion with actionable findings were similar in EP and LEP cohorts (29.6% vs. 26.7%). CONCLUSIONS Accounting for demographic differences, ADI acquisition was similar for ED patients with and without LEP. Further research is needed to determine optimal interpretation modalities in this setting to prevent unnecessary imaging.
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Affiliation(s)
- Neeraj Chhabra
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois; University of Illinois Chicago, Chicago, Illinois
| | - Errick Christian
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois
| | - Veronika Seseri
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois; University of Illinois Chicago, Chicago, Illinois
| | - Faith George
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois; University of Illinois Chicago, Chicago, Illinois
| | - Lum Rizvanolli
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois
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Lane-Fall MB. What We Can Learn About Care Inequities From Unilateral Do-Not-Resuscitate Orders. Crit Care Med 2023; 51:1096-1098. [PMID: 37439644 DOI: 10.1097/ccm.0000000000005929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
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Valdez JJ, Jackson AV, Marshall C. Association between primary Spanish language and quality of intrapartum care among Latina women: a secondary analysis of the Listening to Mothers in California survey. BMC Pregnancy Childbirth 2023; 23:212. [PMID: 36978018 PMCID: PMC10045194 DOI: 10.1186/s12884-023-05526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/17/2022] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Language barriers play significant roles in quality of healthcare. Limited studies have examined the relationships between Spanish language and quality of intrapartum care. The objective was to determine the association between primary Spanish language and quality of intrapartum care so as to further inform best practices for non-English speaking patients in the labor and delivery setting. METHODS We used the 2016 Listening to Mothers in California survey data, which included a statewide representative sample of women who gave birth in hospitals. Our analytical sample included 1202 Latina women. Multivariable logistic regression was used to examine the association between primary language (monolingual English vs. monolingual Spanish vs. bilingual Spanish/English) and perceived discrimination due to language, perceived pressure for medical interventions, and mistreatment during labor, adjusting for maternal sociodemographics and other maternal and neonatal factors. RESULTS Over one-third of the study population spoke English (35.6%), less than one-third spoke Spanish (29.1%), and greater than one-third spoke bilingual Spanish/English (35.3%). Overall, 5.4% of Latina women perceived discrimination due to language spoken, 23.1% perceived pressure for any medical intervention, and 10.1% experienced either form of mistreatment. Compared to English-speakers, Spanish-speakers were significantly more likely to report discrimination due to language (aOR 4.36; 95% CI 1.15-16.59), but were significantly less likely to experience pressure for certain medical interventions (labor induction or cesarean delivery) during labor (aOR 0.34; 95% CI 0.15-0.79 for induction; aOR 0.44; 95% CI 0.18-0.97 for cesarean delivery). Bilingual Spanish/English-speakers also significantly reported discrimination due to language to a lesser extent than monolingual Spanish-speakers (aOR 3.37; 95% CI 1.12-10.13). Any form of Spanish language (monolingual or bilingual) was not significantly associated with mistreatment. CONCLUSIONS Spanish language may contribute to experiences of discrimination during intrapartum care among Latina women. Future research is needed to explore perceptions of pressure, discrimination and mistreatment, among patients with limited English proficiency.
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Affiliation(s)
- Jessica J Valdez
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
- University of California, San Francisco, School of Medicine, 513 Parnassus Ave, S-245, San Francisco, CA, 94143, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Andrea V Jackson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Raff L, Moore C, Raff E. The role of language barriers on efficacy of rapid response teams. Hosp Pract (1995) 2023; 51:29-34. [PMID: 36400063 DOI: 10.1080/21548331.2022.2150416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Rapid response (RR) systems are associated with decreased hospital mortality. Systemic biases and inequities can negatively impact RR outcomes. Language barriers between patients and providers are associated with worse outcomes, but it is unknown if language barriers are associated with RR outcomes. METHODS We analyzed all adult hospitalized patients who experienced a RR over one year (January 2020 to December 2020) at a tertiary care academic medical center. We used an objective scoring system to establish disease severity at the time of the event. We then compared disease severity and outcomes for patients who are primary language Spanish (PLS) and primary language English (PLE) using both univariable and multivariable analyses. RESULTS Of 1133 patients, 42 identified as PLS and 1091 as PLE. In multivariable analyses, PLS patients had significantly higher disease severity scores, as measured by deterioration index score (8.2, p = 0.021) at the time of their rapid responses. PLS patients also had 18.5% increase in length of stay (LOS) after RRs and this disparity was not mitigated when controlling for disease severity at the time of RRs. PLS was not a significant predictor for hospital mortality after RRs. CONCLUSIONS Our study found that PLS patients had increased disease severity at the time of RRs and increased LOS after RRs. However, the disparity in LOS was not mitigated when controlling for disease severity at the time of RRs. These findings suggest that language barriers may cause both delays in activation of RR systems, as well as the care provided during and after RRs.
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Affiliation(s)
- Lauren Raff
- Division of Trauma and Acute Care Surgery, University of North Carolina at Chapel Hill Department of Surgery, Chapel Hill, NC, US
| | - Carlton Moore
- Division of Hospital Medicine, University of North Carolina at Chapel Hill Department of Medicine, Chapel Hill, NC, US
| | - Evan Raff
- Division of Hospital Medicine, University of North Carolina at Chapel Hill Department of Medicine, Chapel Hill, NC, US.,Division of Hospital Medicine, University of North Carolina at Chapel Hill Department of Medicine, 101 Manning Drive, 27599, Chapel Hill, NC, US
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Sonoda K, Takedai T, Salter C. Communication sheet eases barriers for Japanese patients and health professionals. BMC Health Serv Res 2022; 22:976. [PMID: 35907847 PMCID: PMC9339196 DOI: 10.1186/s12913-022-08371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Language and cultural barriers can affect healthcare outcomes of minority populations. However, limited data are available on communication tools developed to address health disparities resulting from language and cultural barriers. Our study aimed to reduce communication barriers between Japanese patients and non-Japanese-speaking clinic staff by developing a Japanese-English Communication Sheet (JECS) to create more equitable clinical environments for Japanese patients in ambulatory care. Methods This study was conducted at a family health center in a United States urban setting, in the city of Pittsburgh, between November 2019 and August 2020. This study included Japanese adult patients who had health care office visits with one of two Japanese-speaking physicians and who completed a survey about the JECS. The JECS, written in Japanese and English, targets common sources of confusion by presenting common health questions, written in Japanese, and by explaining differences between common healthcare processes in Japan and the United States. Clinic staff who used the JECS with Japanese-speaking patients also were surveyed about the tool. Results Sixty Japanese patients met inclusion criteria and completed the survey. More than half of participants found the JECS useful, and those with self-reported limited English proficiency were most likely to report that the JECS was useful (p = 0.02). All nine non-Japanese speaking staff surveyed found the sheet helpful. Conclusions The JECS is a useful communication tool for addressing common barriers faced by Japanese patients seeking care at an American health center where Japanese-speaking physicians work but no clinic staff speak Japanese. A focused communication sheet can facilitate communication between patients and clinic staff and also reduce health inequities resulting from linguistic and cultural barriers. Additionally, using a communication sheet can advance quality and safety of patient care at the individual and institutional level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08371-x.
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Affiliation(s)
- Kento Sonoda
- Department of Family Medicine, University of Pittsburgh Medical Center Shadyside, 5215 Centre Avenue, Pittsburgh, PA, 15232, USA. .,Department of Family and Community Medicine, Saint Louis University, Saint Louis, MO, USA.
| | - Teiichi Takedai
- Department of Family Medicine, University of Pittsburgh Medical Center Shadyside, 5215 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Cynthia Salter
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review. J Gen Intern Med 2022; 37:2050-2061. [PMID: 35112283 PMCID: PMC9198156 DOI: 10.1007/s11606-021-07348-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
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 all-cause 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. PROSPERO REGISTRATION NUMBER CRD42020143477.
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Latif Z, Makuvire T, Feder SL, Wadhera RK, Garan AR, Pinzon PQ, Warraich HJ. Challenges Facing Heart Failure Patients With Limited English Proficiency: A Qualitative Analysis Leveraging Interpreters' Perspectives. JACC. HEART FAILURE 2022; 10:430-438. [PMID: 35370123 DOI: 10.1016/j.jchf.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Limited English proficiency (LEP) heart failure (HF) patients experience worse HF outcomes, including higher readmission rates and emergency department visits. To elucidate the challenges this population faces, the authors interviewed interpreters to identify gaps in care quality and ways to improve care for LEP HF patients. OBJECTIVES The authors sought to understand the challenges facing HF patients with LEP using medical interpreters' perspectives. METHODS The authors conducted a qualitative study using semistructured interviews with interpreters working at an academic medical center. All interpreters employed by the medical center were eligible to participate. Interviews were analyzed using thematic analysis. RESULTS The authors interviewed 20 interpreters from 9 languages (mean age: 48 ± 14.3 years; mean experience: 16.3 ± 10.6 years). Two themes regarding the challenges of care delivery to LEP HF patients emerged: 1) LEP patients often had a limited understanding of HF etiology, prognosis, and treatment options, and interpreters cited difficulty explaining HF given the complexity of the subject; and 2) practical steps to improve the discharge process for LEP HF patients. Integrating interpreters into both the inpatient and outpatient HF teams was a strongly supported intervention. Additionally, conducting pre-encounter huddles, providing the interpreter service phone number at the time of discharge, involving family members when appropriate, and considering nutrition referrals were all important steps highlighted by interpreters. CONCLUSIONS This study illuminates challenges that LEP HF patients face and provides potential solutions to improve care for this vulnerable group. Integrating interpreters as part of the HF team and designing practical discharge plans for LEP HF patients could reduce current disparities.
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Affiliation(s)
- Zara Latif
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Makuvire
- Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shelli L Feder
- Yale University School of Nursing, Orange, Connecticut, USA
| | - Rishi K Wadhera
- Harvard Medical School, Boston, Massachusetts, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - A Reshad Garan
- Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Pablo Quintero Pinzon
- Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Haider J Warraich
- Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Medicine, Cardiology Section, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
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Clark JR, Shlobin NA, Batra A, Liotta EM. The Relationship Between Limited English Proficiency and Outcomes in Stroke Prevention, Management, and Rehabilitation: A Systematic Review. Front Neurol 2022; 13:790553. [PMID: 35185760 PMCID: PMC8850381 DOI: 10.3389/fneur.2022.790553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/11/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Individuals with limited English proficiency (LEP) face structural challenges to communication in English-speaking healthcare environments. We performed a systematic review to characterize the relationship between LEP and outcomes in stroke prevention, management, and recovery. Methods A systematic review was conducted using the PubMed, Embase, Scopus, and Web of Science databases. Titles and abstracts from articles identified were read and selected for full text review. Studies meeting inclusion criteria were reviewed in full for study design, aim, and outcomes. Results Of 891 unique articles, 20 were included. Eleven articles did not provide information about interpreter availability or usage, limiting the ability to draw conclusions about the effect of LEP on measured outcomes in these studies. Overall, studies demonstrated that English proficiency is associated with better outcomes in preventive aspects of stroke care such as stroke symptom awareness, anticoagulation maintenance, and knowledge of warfarin indication. Some acute stroke care metrics were independent of English proficiency in seven studies while other evidence showed associations between interpreter requirement and quality of inpatient care received. LEP and English-proficient groups show similar mortality despite greater lengths of stay and greater proportions of care in dedicated stroke units for LEP patients. Post-stroke quality of life can be worse for those with LEP, and language barriers can negatively impact patient and provider experiences of rehabilitation. Conclusions Stroke patients with LEP face barriers to equitable care at multiple stages. While some studies demonstrate worse outcomes for LEP patients, equitable care was shown in multiple studies frequently in the setting of a high degree of interpreter availability. Patients with LEP will benefit from tailored education regarding stroke symptom recognition and medication regimens, and from provision of translated written educational material. Inequities in inpatient care and rehabilitation exist despite similar mortality rates in four studies. Future studies should report interpreter availability and usage within LEP groups and whether patient interactions were language-concordant or discordant in order to allow for more generalizable and reliable conclusions.
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Reaume M, Batista R, Talarico R, Guerin E, Rhodes E, Carson S, Prud'homme D, Tanuseputro P. In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients. J Patient Saf 2022; 18:e196-e204. [PMID: 32433437 DOI: 10.1097/pts.0000000000000726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Research examining the impact of language barriers on patient safety is limited. We conducted a population-based study to determine whether patients whose primary language is not English are more likely to experience harm when admitted to hospitals in Ontario, Canada. METHODS We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2010 to 2015) who were subsequently admitted to hospital. Patient language (obtained from home care assessments) was coded as English, French, or other. Harmful events were identified using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. RESULTS We included 190,724 patients (156,186 Anglophones, 5,110 Francophones, and 29,428 Allophones). There was no significant difference in the unadjusted risk of harm for Francophones compared with Anglophones (relative risk [RR], 0.94; 95% confidence interval [CI], 0.87-1.02). However, Allophones were more likely to experience harm when compared with Anglophones (RR, 1.14; 95% CI, 1.10-1.18). The risk of harm was even greater for Allophones with low English proficiency (RR, 1.18; 95% CI, 1.13-1.24). After adjusting for potential confounders, Anglophones and Allophones were equally likely to experience harm of any type, but Allophones more likely to experience harm from infections and procedures. CONCLUSIONS Patients whose primary language was not English or French were more likely to experience harm after admission to hospital, especially if they had low English proficiency. For these patients, the risk of harm from infections and procedures persisted in the adjusted analysis, but the overall risk of harm did not.
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Affiliation(s)
| | | | | | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, Ontario
| | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario
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13
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Reaume M, Batista R, Rhodes E, Knight B, Imsirovic H, Seale E, Riad K, Prud'homme D, Tanuseputro P. The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients. Med Care 2021; 59:1006-1013. [PMID: 34432768 DOI: 10.1097/mlr.0000000000001638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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 (2015-2017) 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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Affiliation(s)
- Michael Reaume
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Ricardo Batista
- Institut du Savoir Montfort
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
| | - Braden Knight
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Haris Imsirovic
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Emily Seale
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Karine Riad
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Denis Prud'homme
- Institut du Savoir Montfort
- Faculty of Health Sciences, University of Ottawa
| | - Peter Tanuseputro
- Faculty of Medicine, University of Ottawa
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
- Bruyère Research Institute, Ottawa, Canada
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14
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Schulson L, Lin MY, Paasche-Orlow MK, Hanchate AD. Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:2683-2691. [PMID: 33528781 PMCID: PMC8390610 DOI: 10.1007/s11606-020-06523-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. OBJECTIVE Estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates vary at hospitals with a high versus low proportion of LEP patients. DESIGN Retrospective cohort study of California's 2017 inpatient and ED administrative data PARTICIPANTS: Community-dwelling individuals ≥ 18 years without a primary diagnosis of pregnancy or childbirth. LEP patients had a principal language other than English. MAIN MEASURES We used a series of linear probability models with incremental sets of covariates, including patient demographics, primary diagnosis, and Elixhauser comorbidities, to examine admission rate for visits of LEP versus EP patients. We then added an interaction covariate for high versus low LEP-serving hospital. We estimated models with and without hospital-level random effects. KEY RESULTS These analyses included 9,641,689 ED visits; 14.7% were for LEP patients. . Observed rate of admission for all ACSC ED visits was higher for LEP than for EP patients (26.2% vs. 25.2; p value < .001). Adjusted rate of admission was not statistically significant (27.3% [95% CI 25.4-29.3%] vs. 26.2% [95% CI 24.3-28.1%]). For COPD, the difference was significant (36.8% [95% CI 35.0-38.6%] vs. 33.3% [95% CI 31.7-34.9%]). Difference in adjusted admission rate for LEP versus EP visits did not differ in high versus low LEP-serving hospitals. CONCLUSIONS In adjusted analyses, LEP was not a risk factor for admission for most ACSCs. This finding was observed in both high and low LEP-serving hospitals.
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Affiliation(s)
- Lucy Schulson
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. .,RAND Corporation, 20 Park Plaza #920, Boston, MA, 02116, USA.
| | - Meng-Yun Lin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael K Paasche-Orlow
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Amresh D Hanchate
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Schaefer KM, Modest AM, Hacker MR, Chie L, Connor Y, Golen T, Molina RL. Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study. Matern Child Health J 2021; 25:1110-1117. [PMID: 33904024 DOI: 10.1007/s10995-021-03129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery. METHODS We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011-2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission. RESULTS Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72-0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found. DISCUSSION After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.
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Affiliation(s)
| | - Anna M Modest
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Michele R Hacker
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Lucy Chie
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Yamicia Connor
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Toni Golen
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA
| | - Rose L Molina
- Harvard Medical School, Boston, MA, USA.
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
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16
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Seman M, Karanatsios B, Simons K, Falls R, Tan N, Wong C, Barrington-Brown C, Cox N, Neil CJ. The impact of cultural and linguistic diversity on hospital readmission in patients hospitalized with acute heart failure. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:121-129. [PMID: 31332442 DOI: 10.1093/ehjqcco/qcz034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/29/2019] [Accepted: 07/18/2019] [Indexed: 12/27/2022]
Abstract
AIMS Health services worldwide face the challenge of providing care for increasingly culturally and linguistically diverse (CALD) populations. The aims of this study were to determine whether CALD patients hospitalized with acute heart failure (HF) are at increased risk of rehospitalization and emergency department (ED) visitation after discharge, compared to non-CALD patients, and within CALD patients to ascertain the impact of limited English proficiency (LEP) on outcomes. METHODS AND RESULTS A cohort of 1613 patients discharged from hospital following an episode of acute HF was derived from hospital administrative datasets. CALD status was based on both country of birth and primary spoken language. Comorbidities, HF subtype, age, sex and socioeconomic status, and hospital readmission and ED visitation incidences, were compared between groups. A Cox proportional hazard model was employed to adjust for potential confounders. The majority of patients were classified as CALD [1030 (64%)]. Of these, 488 (30%) were designated as English proficient (CALD-EP) and 542 (34%) were designated CALD-LEP. Compared to non-CALD, CALD-LEP patients exhibited a greater cumulative incidence of HF-related readmission and ED visitation, as expressed by an adjusted hazard ratio (HR) [1.27 (1.02-1.57) and 1.40 (1.18-1.67), respectively]; this difference was not significant for all-cause readmission [adjusted HR 1.03 (0.88-1.20)]. CALD-EP showed a non-significant trend towards increased rehospitalization and ED visitation. CONCLUSION This study suggests that CALD patients with HF, in particular those designated as CALD-LEP, have an increased risk of HF rehospitalization and ED visitation. Further research to elucidate the underlying reasons for this disparity are warranted.
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Affiliation(s)
- Michael Seman
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Bill Karanatsios
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia
| | - Koen Simons
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Roman Falls
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Neville Tan
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia
| | - Chiew Wong
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Christopher Barrington-Brown
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia
| | - Nicholas Cox
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Christopher J Neil
- Western Centre for Health Research and Education, Western Health, Sunshine Hospital, Furlong Road, St. Albans, Melbourne 3021, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
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17
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Schulson LB, Novack V, Folcarelli PH, Stevens JP, Landon BE. Inpatient patient safety events in vulnerable populations: a retrospective cohort study. BMJ Qual Saf 2020; 30:bmjqs-2020-011920. [PMID: 33106277 DOI: 10.1136/bmjqs-2020-011920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Widespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased risk of patient safety events. OBJECTIVE To examine differences in inpatient patient safety events for vulnerable populations defined by race/ethnicity, insurance status and limited English proficiency (LEP). DESIGN Retrospective cohort study. SETTING Single tertiary care academic medical centre. PARTICIPANTS Inpatient admissions of those aged ≥18 years from 1 October 2014 to 31 December 2018. MEASUREMENTS Primary exposures of interest were self-identified race/ethnicity, Medicaid insurance/uninsured and LEP. The primary outcome of interest was the total number of patient safety events, defined as any event identified by a modified version of the Institute for Healthcare Improvement global trigger tool that automatically identifies patient safety events ('automated') from the electronic record or by the hospital-wide voluntary provider reporting system ('voluntary'). Negative binomial models were used to adjust for demographic and clinical factors. We also stratified results by automated and voluntary. RESULTS We studied 141 877 hospitalisations, of which 13.6% had any patient safety event. In adjusted analyses, Asian race/ethnicity was associated with a lower event rate (incident rate ratio (IRR) 0.89, 95% CI 0.83 to 0.96); LEP patients had a lower risk of any patient safety event and voluntary events (IRR 0.91, 95% CI 0.87 to 0.96; IRR 0.89, 95% CI 0.85 to 0.94). Asian and Latino race/ethnicity were also associated with a lower rate of voluntary events but no difference in risk of automated events. Black race was associated with an increased risk of automated events (IRR 1.11, 95% CI 1.03 to 1.20). LIMITATIONS This is a single centre study. CONCLUSIONS A commonly used method for monitoring patient safety problems, namely voluntary incident reporting, may underdetect safety events in vulnerable populations.
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Affiliation(s)
- Lucy B Schulson
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- The RAND Corportation, Boston, MA, USA
| | - Victor Novack
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Patricia H Folcarelli
- Health Care Quality, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jennifer P Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division for Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bruce E Landon
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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18
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Riad K, Webber C, Batista R, Reaume M, Rhodes E, Knight B, Prud'homme D, Tanuseputro P. The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents. BMC Geriatr 2020; 20:397. [PMID: 33032528 PMCID: PMC7545542 DOI: 10.1186/s12877-020-01806-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Karine Riad
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | | | - Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Canada.,Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.,ICES, Ottawa, Canada
| | - Michael Reaume
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Emily Rhodes
- Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | | | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Canada. .,Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
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Mirza M, Harrison EA, Roman M, Miller KA, Jacobs EA. Walking the talk: understanding how language barriers affect the delivery of rehabilitation services. Disabil Rehabil 2020; 44:301-314. [DOI: 10.1080/09638288.2020.1767219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth A. Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marissa Roman
- Rehabilitation Sciences Program, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathryn A. Miller
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Elizabeth A. Jacobs
- Departments of Population Health and Internal Medicine, University of Texas, Austin, TX, USA
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20
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Lu T, Myerson R. Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016. J Gen Intern Med 2020; 35:1490-1497. [PMID: 31898137 PMCID: PMC7210354 DOI: 10.1007/s11606-019-05609-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/15/2019] [Accepted: 12/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes. OBJECTIVE To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016. DESIGN We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents. PARTICIPANTS Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency. MAIN MEASURES Insurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care. KEY RESULTS Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency. CONCLUSIONS Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.
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Affiliation(s)
- Tianyi Lu
- University of Southern California (USC) School of Pharmacy and Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Rebecca Myerson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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21
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Reaume M, Batista R, Talarico R, Rhodes E, Guerin E, Carson S, Prud'homme D, Tanuseputro P. The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada. BMC Health Serv Res 2020; 20:340. [PMID: 32316965 PMCID: PMC7175496 DOI: 10.1186/s12913-020-05213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/13/2020] [Indexed: 02/03/2023] Open
Abstract
Background Patients who live in minority language situations are generally more likely to experience poor health outcomes, including harmful events. The delivery of healthcare services in a language-concordant environment has been shown to mitigate the risk of poor health outcomes related to chronic disease management in primary care. However, data assessing the impact of language-concordance on the risk of in-hospital harm are lacking. We conducted a population-based study to determine whether admission to a language-discordant hospital is a risk factor for in-hospital harm. Methods We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2007 to 2015) who were admitted to a hospital in Eastern or North-Eastern Ontario, Canada. Patient language (obtained from home care assessments) was coded as English (Anglophone group), French (Francophone group), or other (Allophone group); hospital language (English or bilingual) was obtained using language designation status according to the French Language Services Act. We identified in-hospital harmful events using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. Results The proportion of hospitalizations with at least 1 harmful event was greater for Allophones (7.63%) than for Anglophones (6.29%, p < 0.001) and Francophones (6.15%, p < 0.001). Overall, Allophones admitted to hospitals required by law to provide services in both French and English (bilingual hospitals) had the highest rate of harm (9.16%), while Francophones admitted to these same hospitals had the lowest rate of harm (5.93%). In the unadjusted analysis, Francophones were less likely to experience harm in bilingual hospitals than in hospitals that were not required by law to provide services in French (English-speaking hospitals) (RR = 0.88, p = 0.048); the opposite was true for Anglophones and Allophones, who were more likely to experience harm in bilingual hospitals (RR = 1.17, p < 0.001 and RR = 1.41, p < 0.001, respectively). The risk of harm was not significant in the adjusted analysis. Conclusions Home care recipients residing in Eastern and North-Eastern Ontario were more likely to experience harm in language-discordant hospitals, but the risk of harm did not persist after adjusting for confounding variables.
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Affiliation(s)
- Michael Reaume
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. .,Institut du Savoir Montfort, Ottawa, Canada.
| | - Ricardo Batista
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa, Canada
| | | | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, Canada
| | - Sarah Carson
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
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Hilder J, Gray B, Stubbe M. Health navigation and interpreting services for patients with limited English proficiency: a narrative literature review. J Prim Health Care 2019; 11:217-226. [DOI: 10.1071/hc18067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONCulturally and linguistically diverse populations (CALD) have significant health outcome disparities compared to dominant groups in high-income countries. The use of both navigators and interpreters are strategies used to address these disparities, but the intersections between these two roles can be poorly understood.
AIMTo gain an overview of the literature on health navigation and similar roles, with particular reference to the New Zealand context, and to explore the interface between these roles and that of interpreters for CALD populations with limited English proficiency.
METHODSA narrative review of the literature was conducted using a range of search strategies and a thematic analysis was conducted.
RESULTSThere are several barriers to health-care access relating to health systems and CALD populations. For over 50 years, health workers who are members of these communities have been used to address these barriers, but there are many terms describing workers with wide-ranging roles. There is some evidence of efficacy in economic, psychosocial and functional terms. For health navigation services to work, they need to have staff who are well selected, trained and supported; are integrated into health-care teams; and have clearly defined roles. There may be a place for integrating interpreting more formally into the navigator role for members of communities who have limited English proficiency.
CONCLUSIONTo achieve better access to health care for CALD populations, there is an argument for adding another member to the health team who combines clearly defined aspects of the roles of interpreter, community health worker and navigator. Organisations considering setting up such a position should have a clear target population, carefully consider the barriers they are trying to address and define a role, scope of practice and training requirements best suited to addressing those barriers.
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Is 30-Day Posthospitalization Mortality Lower Among Racial/Ethnic Minorities?: A Reexamination. Med Care 2018; 56:665-672. [PMID: 29877955 DOI: 10.1097/mlr.0000000000000938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple studies have reported that risk-adjusted rates of 30-day mortality after hospitalization for an acute condition are lower among blacks compared with whites. OBJECTIVE To examine if previously reported lower mortality for minorities, relative to whites, is accounted for by adjustment for do-not-resuscitate status, potentially unconfirmed admission diagnosis, and differential risk of hospitalization. RESEARCH DESIGN Using inpatient discharge and vital status data for patients aged 18 and older in California, we examined all admissions from January 1, 2010 to June 30, 2011 for acute myocardial infarction, heart failure, pneumonia, acute stroke, gastrointestinal bleed, and hip fracture and estimated relative risk of mortality for Hispanics, non-Hispanic blacks, non-Hispanic Asians, and non-Hispanic whites. Multiple mortality measures were examined: inpatient, 30-, 90-, and 180 day. Adding census data we estimated population risks of hospitalization and hospitalization with inpatient death. RESULTS Across all mortality outcomes, blacks had lower mortality rate, relative to whites even after exclusion of patients with do-not-resuscitate status and potentially unconfirmed diagnosis. Compared with whites, the population risk of hospitalization was 80% higher and risk of hospitalization with inpatient mortality was 30% higher among blacks. Among Hispanics and Asians, disparities varied with mortality measure. CONCLUSIONS Lower risk of posthospitalization mortality among blacks, relative to whites, may be associated with higher rate of hospitalizations and differences in unobserved patient acuity. Disparities for Hispanics and Asians, relative to whites, vary with the mortality measure used.
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Squires A, Peng TR, Barrón-Vaya Y, Feldman P. An Exploratory Analysis of Patient-Provider Language-Concordant Home Health Care Visit Patterns. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017; 29:161-167. [PMID: 34257503 DOI: 10.1177/1084822317696706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Approximately one in five households in the United States speaks a language other than English at home. This exploratory, descriptive study sought to examine language-concordant visit patterns in an urban home health care agency serving a diverse and multilingual population. Patient care record data combined with administrative data facilitated the exploratory work. In a 2-year period, results showed that among the 238,513 visits with 18,132 limited English proficiency patients, only 20% of visits were language concordant. The study suggests that home health care services may not be meeting the demand for language services, but more research is needed to determine the right "dose" of bilingual home care visits to optimize home care outcomes and establish a standard for care.
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Affiliation(s)
| | - Timothy R Peng
- Visiting Nurse Service of New York, New York City, NY, USA
| | | | - Penny Feldman
- Visiting Nurse Service of New York, New York City, NY, USA
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25
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Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency. Med Care 2017; 55:199-206. [PMID: 27579909 PMCID: PMC5309198 DOI: 10.1097/mlr.0000000000000643] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. OBJECTIVE To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. DESIGN Natural experiment on a medicine floor of an academic hospital. PARTICIPANTS Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. EXPOSURE Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. OUTCOME MEASURES Thirty-day readmission, length of stay, estimated hospital expenditures. RESULTS Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. CONCLUSIONS Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.
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Affiliation(s)
- Leah S Karliner
- Department of Medicine, Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, CA
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26
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Rostanski SK, Williams O, Stillman JI, Marshall RS, Willey JZ. Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics. Neurol Clin Pract 2016; 6:389-396. [PMID: 27847681 DOI: 10.1212/cpj.0000000000000287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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 = 0.06). Similarly, the proportion of stroke mimics did not differ between English- and Spanish-speaking patients (15.8% vs 11.5%, p = 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.
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Affiliation(s)
- Sara K Rostanski
- Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY
| | - Olajide Williams
- Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY
| | - Joshua I Stillman
- Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY
| | - Randolph S Marshall
- Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY
| | - Joshua Z Willey
- Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY
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Rostanski SK, Stillman J, Williams O, Marshall RS, Yaghi S, Willey JZ. The Influence of Language Discordance Between Patient and Physician on Time-to-Thrombolysis in Acute Ischemic Stroke. Neurohospitalist 2016; 6:107-10. [PMID: 27366293 DOI: 10.1177/1941874416637405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Reducing door-to-imaging (DIT) time is a major focus of acute stroke quality improvement initiatives to promote rapid thrombolysis. However, recent data suggest that the imaging-to-needle (ITN) time is a greater source of treatment delay. We hypothesized that language discordance between physician and patient would contribute to prolonged ITN time, as rapidly taking a history and confirming last known well require facile communication between physician and patient. METHODS This is a retrospective analysis of all patients who received tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2014. Baseline characteristics and relevant time intervals were compared between encounters where the treating neurologist and patient spoke the same language (concordant cases) and where they did not (discordant cases). RESULTS A total of 279 patients received tPA during the study period. English was the primary language for 51%, Spanish for 46%, and other languages for 3%; 59% of cases were classified as language concordant and 41% as discordant. We found no differences in median DIT (24 vs 25, P = .5), ITN time (33 vs 30, P = .3), or door-to-needle time (DTN; 58 vs 55, P = .1) between concordant and discordant groups. Similarly, among patients with the fastest and slowest ITN times, there were no differences. CONCLUSION In a high-volume stroke center with a large proportion of Spanish speakers, language discordance was not associated with changes in DIT, ITN time, or DTN time.
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Affiliation(s)
- Sara K Rostanski
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Joshua Stillman
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Olajide Williams
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Randolph S Marshall
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joshua Z Willey
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Davies SE, Dodd KJ, Hill KD. Does cultural and linguistic diversity affect health-related outcomes for people with stroke at discharge from hospital? Disabil Rehabil 2016; 39:736-745. [DOI: 10.3109/09638288.2016.1161839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah E. Davies
- Physiotherapy Department, Northern Health, Melbourne, Victoria, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Karen J. Dodd
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Language disparities in patients transported by emergency medical services. Am J Emerg Med 2015; 33:1737-41. [DOI: 10.1016/j.ajem.2015.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 11/20/2022] Open
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