Patient comprehension of doctor-patient communication on discharge from the emergency department

Crane, John A.

doi:10.1016/s0736-4679(96)00261-2

Cited by 224 publications

(141 citation statements)

References 39 publications

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“…Language barriers have been shown to compromise patient understanding of discharge instructions, which may affect long-term outcomes. 10 Fourth, we were unable to assess quality of care or the extent of language access services, which may have yielded important differences in processes of care and outcomes. Finally, our findings in Medicaid patients may not generalize to other socioeconomic groups.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that language barriers result in poorer quality of care, worse outcomes, and decreased satisfaction in the outpatient and emergency settings. [2][3][4][5][6][7][8][9][10][11] In psychiatric settings, patients with limited English proficiency are less likely to have an adequate evaluation and diagnosis. 12,13 Similarly, patients with limited English proficiency in palliative care settings are less likely to have adequate symptom control; 14 and NEP patients are more likely to have nonsterile deliveries in obstetrical settings.…”

Section: Introductionmentioning

confidence: 99%

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Acute Myocardial Infarction Length of Stay and Hospital Mortality Are Not Associated with Language Preference

et al. 2007

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BACKGROUND:Language barriers between patients and providers may influence the process and quality of care. OBJECTIVE:To examine the association of language preference with length of stay (LOS) and in-hospital mortality for patients admitted for acute myocardial infarction (AMI). DESIGN, SETTING, AND PARTICIPANTS:Electronic administrative hospital discharge data for all nondisabled Medicaid beneficiaries age 35 years and older admitted to all acute care California hospitals with a diagnosis of AMI between 1994 and 1998. METHODS:We used multivariate regression to explore whether observed differences in the hospital LOS and in-hospital mortality between non-English preference (NEP) and English preference (EP) individuals could be explained by individual and/or hospital level factors. We adjusted for patient level characteristics using 24 covariates from a previously validated prediction model of mortality after hospitalization for AMI.RESULTS: Of 12,609 Medicaid patients across 401 California hospitals, 2,757 (22%) had NEP. NEP was associated with a 3.9% increased LOS (95% CI 0.7, 7.1; p=0.02) in unadjusted analysis and a 3.8% increased LOS (95% CI 0.3, 7.3; p=0.03) after controlling for patient level characteristics. Differences in LOS were no longer significant after adjusting receipt of cardiac procedure/ surgery (2.8%; 95% CI −0.6, 6.2; p=0.1) or after adjusting for hospital (0.9%; 95% CI −2.5, 4.3; p= 0.6). Non-English language preference was associated with lower in-hospital mortality in unadjusted analysis (odds ratio [OR]=0.80; 95% CI 0.69, 0.94; p=0.005), but was not significant after adjusting for patient level characteristics (adjusted OR [AOR] 0.95; 95% CI 0.78, 1.27; p=0.6). Adjusting for receipt of cardiac procedure/ surgery (AOR 0.97; 95% CI 0.79, 1.18; p=0.7) and hospital (AOR 0.97; 95% CI 0.78; 1.21; p=0.8) did not alter this finding.CONCLUSIONS: Language preference is not associated with AMI mortality, and the small increase in length of stay associated with non-English preference is accounted for by hospital level factors. Our results suggest that system level differences are important to consider in studies of the effect of language barriers in the health care setting.KEY WORDS: language preference; communication; limited English proficient; language barrier.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute Myocardial Infarction Length of Stay and Hospital Mortality Are Not Associated with Language Preference

et al. 2007

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“…[3][4][5][6] Even when patients with language barriers do have access to care, they have poorer adherence, decreased comprehension of their diagnoses, decreased satisfaction with care, and increased medication complications. [7][8][9][10] Few studies, however, have examined how language influences outcomes of hospital care. Compared to Englishspeakers, patients who do not speak English well may experience longer lengths of stay, 11 and have more adverse events while in the hospital.…”

mentioning

confidence: 99%

Influence of language barriers on outcomes of hospital care for general medicine inpatients

Karliner

Kim

Meltzer

et al. 2010

Journal of Hospital Medicine

186

119

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BACKGROUND: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency. OBJECTIVE: To examine whether patients' primary language influences hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30‐day readmission or 30‐day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non‐English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non‐English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0‐1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2‐2.3 and OR, 1.5; 95% CI, 1.0‐2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non‐English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post‐hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.

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“…3 Many studies have shown that LEP patients tend to have lower rates of preventive screening and higher rates of hospitalization and drug complications 2,3,9,[11][12][13][14][15] . Lack of discussion and poor understanding of treatment plans, including medication side effects, are likely reasons for these concerning rates, as such factors can lead to patient dissatisfaction and reduce adherence to physician recommendations [16][17][18] . The first systematic review of the impact of medical interpretation on health care concluded that quality of care and related health outcomes are seriously compromised for LEP patients who need but do not receive qualified interpretation services 13 .…”

mentioning

confidence: 99%

Alterations in Medical Interpretation During Routine Primary Care

Jackson

Nguyen

et al. 2010

J GEN INTERN MED

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BACKGROUND: Increasing numbers of patients require medical interpretation, yet few studies have examined its accuracy or effect on health outcomes. OBJECTIVE: To understand how alterations in medical interpretation affect health care delivery to patients with limited English proficiency (LEP), we aimed to determine the frequency, type, and clinical significance of alterations. We focused on best-case encounters that involved trained, experienced interpreters interacting with established patients. DESIGN: We audio-recorded routine outpatient clinic visits in which a medical interpreter participated. Audiotapes were transcribed and translated into English. We identified and characterized alterations in interpretation and calculated their prevalence. PARTICIPANTS: In total, 38 patients, 16 interpreters, and 5 providers took part. Patients spoke Cantonese, Mandarin, Somali, Spanish, and Vietnamese, and received care for common chronic health conditions. MEASURES: Unlike previous methods that report numbers of alterations per interpreted encounter, we focused on alterations per utterance, which we defined as the unit of spoken content given to the interpreter to interpret. All alteration rates were calculated by dividing the number of alterations made during the encounter by the number of utterances for that encounter. We defined clinically significant changes as those with potential consequences for evaluation and treatment. KEY RESULTS: We found that 31% of all utterances during a routine clinical encounter contained an alteration. Only 5% of alterations were clinically significant, with 1% having a positive effect and 4% having a negative effect on the clinical encounter. CONCLUSION: Even in a best case scenario, the rate of alteration remains substantial. Training interpreters and clinicians to address common patterns of alteration will markedly improve the quality of communication between providers and LEP patients.KEY WORDS: interpretation; translation; communication barriers; language; physician-patient relations; limited English proficiency; quality of health care.

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Patient comprehension of doctor-patient communication on discharge from the emergency department

Cited by 224 publications

References 39 publications

Acute Myocardial Infarction Length of Stay and Hospital Mortality Are Not Associated with Language Preference

Acute Myocardial Infarction Length of Stay and Hospital Mortality Are Not Associated with Language Preference

Influence of language barriers on outcomes of hospital care for general medicine inpatients

Alterations in Medical Interpretation During Routine Primary Care

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