A research letter recently published in JAMA examined the correlation between limited English proficiency (LEP) and revisits or readmissions after hospitalization. The study was conducted in 2 academic hospitals in Toronto, Canada, using data from patients who were discharged between 2008 and 2016. The researchers focused on 2 acute conditions (hip fracture and pneumonia) or exacerbations of 2 chronic conditions (chronic obstructive pulmonary disease [COPD] and heart failure). People with LEP were identified by their listed preferred language in hospital databases.
The researchers used multivariable regression models to determine relative risks for 30-day emergency department (ED) visits and readmissions 30 or 90 days after discharge from the hospital. They found that those with LEP were older, more often women, and generally had lower income and more comorbidities than patients with the same conditions who were English proficient (EP). Overall, patients with LEP and heart failure had greater risk for a 30-day ED visit compared with those who were EP and a higher risk for readmission at both 30 and 90 days. Those with LEP and COPD were also at greater risk for readmission in both timeframes; however, they were not significantly more likely to have a 30-day ED visit. Patients with LEP discharged after hospital stays for hip fracture or pneumonia did not show any significant difference in length of stay or readmission rates than patients with EP.
Across the 2 hospitals, patients with LEP and heart failure or COPD had a higher chance of being readmitted to the hospital vs patients who were EP with the same conditions. This is likely because heart failure and COPD are conditions that require complex management, indicating that language barriers could pose a threat to effective care. Patients with LEP generally report lower medication adherence, decreased comprehension of care instructions, and find care transitions difficult vs patients who are EP. By contrast, hip fracture and pneumonia may be “minimally communication sensitive” conditions; that is, ones that do not require complex management. That study found that lengths of stay and mortality rates across patients with LEP and EP were similar, possibly because myocardial infarction is “minimally communication sensitive.” This conclusion points to an increased need for communication during the hospital stay as well as after discharge between patients with LEP and those caring for them.
Because only 2 hospitals in the same network were studied, the research had a somewhat limited scope. Patient factors such as severity of illness, health literacy, and race/ethnicity were also not taken into account, so residual confounding may have been possible. Additionally, there was no distinction made between patients with LEP and patients whose preferred language is not English but who do not have LEP, because it can be difficult to define and measure LEP. Similarly, patient data on use of an interpreter was not available to the researchers, although both hospitals offer medical interpretation services.
The researchers emphasize that when conditions are communication sensitive, hospitals should consider strategies to improve discharge communication and support after discharge between care teams and patients with LEP.
Rawal S, Srighanthan J, Vasantharoopan A, Hu H, Tomlinson G, Cheung AM. Association between limited English proficiency and revisits and readmissions after hospitalization for patients with acute and chronic conditions in Toronto, Ontario, Canada. JAMA. 2019;322(16):1605-1607.