Association of Primary Language and Hospitalization for Ambulatory Care Sensitive Conditions

Abstract

Background: Limited English proficiency is associated with decreased access to ambulatory care, however, it is unclear if this disparity leads to increased use of emergency departments (EDs) for low severity ambulatory care sensitive conditions (ACSCs). Objective:We sought to determine the association between the patient's preferred language and hospital utilization for ACSCs. Research Design:We conducted a retrospective cohort study of all ED visits in New Jersey in 2013 and 2014. The primary outcome was hospital admission for acute ACSCs, chronic ACSCs, and fractures (a nonambulatory care sensitive control condition). Secondary outcomes included intensive care unit (ICU) utilization and length of stay. Mixed-effect regression models estimated the association between preferred language (English vs. non-English) and study outcomes, controlling for demographics, comorbidities, and hospital characteristics. Results:We examined 201,351 ED visits for acute ACSCs, 251,193 visits for chronic ACSCs, and 148,428 visits for fractures, of which 13.5%, 11.1%, and 9.9%, respectively, were by non-English speakers. In adjusted analyses, non-English speakers were less likely to be admitted for acute ACSCs [−3.1%; 95% confidence interval (CI), −3.6% to −2.5%] and chronic ACSCs (−2.3%; 95% CI, −2.8% to −1.7%) but not fractures (0.4%; 95% CI, −0.2% to 1.0%). Among hospitalized patients, non-English speakers were less likely to receive ICU services but had no difference in length of stay.Conclusions: These findings suggest non-English-speaking patients may seek ED care for lower acuity ACSCs than English-speaking patients. Efforts to decrease preventable ED and increase access to ambulatory care use should consider the needs of non-English-speaking patients.

Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study

“…Any individual who selected a language other than English as the principal language used in communicating with healthcare providers was considered LEP. 14,20,21 Those who selected English were considered English proficient. We further categorized LEP based on the most frequent languages in the dataset: Spanish, Chinese (Mandarin and Cantonese), Tagalog, Vietnamese, and other.…”

“…Additionally, few studies have examined if LEP patients have more preventable hospitalizations than EP patients. 14 Admission for an ambulatory care sensitive condition (ACSC) is a quality metric used to identify potentially preventable admissions. 15 Although this metric has been examined in regard to race/ethnicity and insurance status, few studies have examined if LEP patients are at increased risk for admission for ACSCs compared to English proficient patients.…”

“…15 Although this metric has been examined in regard to race/ethnicity and insurance status, few studies have examined if LEP patients are at increased risk for admission for ACSCs compared to English proficient patients. 14 One study using 2013-2014 data from New Jersey found that LEP patients were less likely to be admitted for ACSCs as compared to English proficient patients. 14 The extent to which this pattern generalizes to other states is unknown.…”

“…14 One study using 2013-2014 data from New Jersey found that LEP patients were less likely to be admitted for ACSCs as compared to English proficient patients. 14 The extent to which this pattern generalizes to other states is unknown. Previous studies have not examined the impact of hospital factors on admission.…”

The Language of Equity in Digital Health: Prioritizing the Needs of Limited English Proficient Communities in the Patient Portal 2.0

“…8 Limited English proficient patients already suffer from multiple gaps in care, including poorer access to consistent medical care, higher rates of hospitalization and readmission, and impaired health understanding. [9][10][11][12][13] Moreover, the compounded inequities of the COVID-19 pandemic and the pre-existing lack of access to care (physically and digitally via telemedicine) that disproportionately affect LEP patients have increased the urgency of a comprehensive approach to addressing these digital disparities. 14…”