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Published in:

01-12-2018 | Original Research

Emergency Department Care for Patients with Limited English Proficiency: a Retrospective Cohort Study

Authors: Lucy Schulson, MD, MPH, Victor Novack, MD, PhD, Peter B. Smulowitz, MD, Tenzin Dechen, MPH, Bruce E. Landon, M.D., M.B.A., M.Sc.

Published in: Journal of General Internal Medicine | Issue 12/2018

Abstract

Background

Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED).

Objective

To compare the care processes of LEP patients in the ED.

Design

Retrospective cohort study.

Setting

ED in a large tertiary care academic medical center.

Patients

Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care.

Main Measures

Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED.

Key Results

We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03–1.19) and be admitted to the hospital (OR 1.09, CI 1.01–1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73–1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22–1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02–1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70–0.91), but those preferring “other” languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17–1.57).

Conclusions

ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.

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Boissy A, Windover AK, Bokar D, et al. Communication Skills Training for Physicians Improves Patient Satisfaction. J Gen Intern Med. 2016;31(7):755–761. doi:https://doi.org/10.1007/s11606-016-3597-2 CrossRefPubMedPubMedCentral

Johnson MB, Castillo EM, Harley J, Guss DA. Impact of Patient and Family Communication in a Pediatric Emergency Department on Likelihood to Recommend: Pediatr Emerg Care. 2012;28(3):243–246. doi:https://doi.org/10.1097/PEC.0b013e3182494c83 CrossRefPubMed

Mira JJ, Orozco-Beltrán D, Pérez-Jover V, et al. Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities. Fam Pract. 2013;30(1):56–63. doi:https://doi.org/10.1093/fampra/cms046 CrossRefPubMed

Camille Ryan. Language Use in the United States:2011. American Community Survey Reports. U S Census Bur. http://www.census.gov/prod/2013pubs/acs-22.pdf?cssp=SERP.

DuBard CA, Gizlice Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98(11):2021–2028. doi:https://doi.org/10.2105/AJPH.2007.119008 CrossRefPubMedPubMedCentral

Fernandez A, Schillinger D, Warton EM, et al. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE). J Gen Intern Med. 2011;26(2):170–176. doi:https://doi.org/10.1007/s11606-010-1507-6 CrossRefPubMed

Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5(5):276–282. doi:https://doi.org/10.1002/jhm.658 CrossRefPubMed

Rodriguez F, Hong C, Chang Y, et al. Limited English proficient patients and time spent in therapeutic range in a warfarin anticoagulation clinic. J Am Heart Assoc. 2013;2(4):e000170. doi:https://doi.org/10.1161/JAHA.113.000170 CrossRefPubMedPubMedCentral

Wisnivesky JP, Krauskopf K, Wolf MS, et al. The association between language proficiency and outcomes of elderly patients with asthma. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2012;109(3):179–184. doi:https://doi.org/10.1016/j.anai.2012.06.016 CrossRef

10.

Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care J Int Soc Qual Health Care. 2007;19(2):60–67. doi:https://doi.org/10.1093/intqhc/mzl069 CrossRef

11.

John-Baptiste A, Naglie G, Tomlinson G, et al. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19(3):221–228.CrossRef

12.

Kim EJ, Kim T, Paasche-Orlow MK, Rose AJ, Hanchate AD. Disparities in Hypertension Associated with Limited English Proficiency. J Gen Intern Med. 2017;32(6):632–639. doi:https://doi.org/10.1007/s11606-017-3999-9 CrossRefPubMedPubMedCentral

13.

Leung LB, Vargas-Bustamante A, Martinez AE, Chen X, Rodriguez HP. Disparities in Diabetes Care Quality by English Language Preference in Community Health Centers. Health Serv Res. October 2016. doi:https://doi.org/10.1111/1475-6773.12590 CrossRef

14.

Hahn EA, Burns JL, Jacobs EA, et al. Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes. J Health Commun. 2015;20(sup2):4–15. doi:https://doi.org/10.1080/10810730.2015.1061071 CrossRefPubMed

15.

Arthur KC, Mangione-Smith R, Meischke H, et al. Impact of English proficiency on care experiences in a pediatric emergency department. Acad Pediatr. 2015;15(2):218–224. doi:https://doi.org/10.1016/j.acap.2014.06.019 CrossRefPubMed

16.

Karliner LS, Auerbach A, Nápoles A, Schillinger D, Nickleach D, Pérez-Stable EJ. Language Barriers and Understanding of Hospital Discharge Instructions: Med Care. 2012;50(4):283–289. doi:https://doi.org/10.1097/MLR.0b013e318249c949 CrossRefPubMedPubMedCentral

17.

Schenker Y, Pérez-Stable EJ, Nickleach D, Karliner LS. Patterns of interpreter use for hospitalized patients with limited English proficiency. J Gen Intern Med. 2011;26(7):712–717. doi:https://doi.org/10.1007/s11606-010-1619-z CrossRefPubMedPubMedCentral

18.

Ramirez D, Engel KG, Tang TS. Language interpreter utilization in the emergency department setting: a clinical review. J Health Care Poor Underserved. 2008;19(2):352–362. doi:https://doi.org/10.1353/hpu.0.0019 CrossRefPubMed

19.

Gallagher RA, Porter S, Monuteaux MC, Stack AM. Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013;29(5):579–583. doi:https://doi.org/10.1097/PEC.0b013e31828e62f4 CrossRefPubMed

20.

Ngai KM, Grudzen CR, Lee R, Tong VY, Richardson LD, Fernandez A. The Association Between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours. Ann Emerg Med. 2016;68(2):213–221. doi:https://doi.org/10.1016/j.annemergmed.2016.02.042 CrossRefPubMedPubMedCentral

21.

Johns Hopkins University. Improving the Emergency Department Discharge Process: Environment Scan Report. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

22.

Njeru JW, St Sauver JL, Jacobson DJ, et al. Emergency department and inpatient health care utilization among patients who require interpreter services. BMC Health Serv Res. 2015;15:214. doi:https://doi.org/10.1186/s12913-015-0874-4 CrossRefPubMedPubMedCentral

23.

Waxman MA, Levitt MA. Are diagnostic testing and admission rates higher in non-English-speaking versus English-speaking patients in the emergency department? Ann Emerg Med. 2000;36(5):456–461. doi:https://doi.org/10.1067/mem.2000.108315 CrossRefPubMed

24.

Bernstein J, Bernstein E, Dave A, et al. Trained medical interpreters in the emergency department: effects on services, subsequent charges, and follow-up. J Immigr Health. 2002;4(4):171–176. doi:https://doi.org/10.1023/A:1020125425820 CrossRefPubMed

25.

Jacobs EA, Fu PC, Rathouz PJ. Does a Video-Interpreting Network Improve Delivery of Care in the Emergency Department? Health Serv Res. 2012;47(1pt2):509–522. doi:https://doi.org/10.1111/j.1475-6773.2011.01329.x CrossRefPubMedPubMedCentral

26.

Doupe MB, Palatnick W, Day S, et al. Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med. 2012;60(1):24–32. doi:https://doi.org/10.1016/j.annemergmed.2011.11.036 CrossRefPubMed

27.

Centers for Disease Control and Prevention. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). 2013. http://www.cdc.gov/nchs/icd/icd9cm. htm.

28.

Emergency Severity Index (ESI): A Triage Tool for Emergency Department. Rockville, MD: Agency for Healthcare Research and Quality; 2013. http://www.ahrq.gov/professionals/systems/hospital/esi/index.html.

29.

Hampers LC, Cha S, Gutglass DJ, Binns HJ, Krug SE. Language barriers and resource utilization in a pediatric emergency department. Pediatrics. 1999;103(6 Pt 1):1253–1256.CrossRef

30.

Levas MN, Cowden JD, Dowd MD. Effects of the limited English proficiency of parents on hospital length of stay and home health care referral for their home health care-eligible children with infections. Arch Pediatr Adolesc Med. 2011;165(9):831–836. doi:https://doi.org/10.1001/archpediatrics.2011.61 CrossRefPubMed

31.

Rogers AJ, Delgado CA, Simon HK. The effect of limited English proficiency on admission rates from a pediatric ED: stratification by triage acuity. Am J Emerg Med. 2004;22(7):534–536.CrossRef

32.

Hsieh E. Not just “getting by”: factors influencing providers’ choice of interpreters. J Gen Intern Med. 2015;30(1):75–82. doi:https://doi.org/10.1007/s11606-014-3066-8 CrossRefPubMed

Title: Emergency Department Care for Patients with Limited English Proficiency: a Retrospective Cohort Study
Authors: Lucy Schulson, MD, MPH
Victor Novack, MD, PhD
Peter B. Smulowitz, MD
Tenzin Dechen, MPH
Bruce E. Landon, M.D., M.B.A., M.Sc.
Publication date: 01-12-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 12/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-018-4493-8

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Background

Objective

Design

Setting

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Main Measures

Key Results

Conclusions

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