The Association between Limited English Proficiency and Sepsis Mortality

Abstract

BACKGROUND: Limited English proficiency (LEP) has been implicated in poor health outcomes. Sepsis is a frequently fatal syndrome that is commonly encountered in hospital medicine. The impact of LEP on sepsis mortality is not currently known. OBJECTIVE: To determine the association between LEP and sepsis mortality. DESIGN: Retrospective cohort study. SETTING: 800-bed, tertiary care, academic medical center. PATIENTS: Electronic health record data were obtained for adults admitted to the hospital with sepsis between June 1, 2012 and December 31, 2016. MEASUREMENTS: The primary predictor was LEP. Patients were defined as having LEP if their self-reported primary language was anything other than English and interpreter services were required during hospitalization. The primary outcome was inpatient mortality. Mortality was compared across races stratified by LEP using chi-squared tests of significance. Bivariable and multivariable logistic regressions were performed to investigate the association between mortality, race, and LEP, adjusting for baseline characteristics, comorbidities, and illness severity. RESULTS: Among 8,974 patients with sepsis, we found that 1 in 5 had LEP, 62% of whom were Asian. LEP was highly associated with death across all races except those identifying as Black and Latino. LEP was associated with a 31% increased odds of mortality after adjusting for illness severity, comorbidities, and other baseline characteristics, including race (OR 1.31, 95% CI 1.06-1.63, P = .02). CONCLUSIONS: In a single-center study of patients hospitalized with sepsis, LEP was associated with mortality across nearly all races. This is a novel finding that will require further exploration into the causal nature of this association.

Predictors to forgo resuscitative effort during Covid-19 critical illness at the height of the pandemic : A retrospective cohort study

“…There have also been concerns that limitation of inperson family-provider contact to restrict virus transmission would negatively impact patients with limited English proficiency. 17,18 Our cohort analysis suggests that language preference was not associated with disproportionate code status reversal or delayed time to initial goals of care conversation, an outcome metric that may capture the impact of strained communication. This suggests that intensive care unit providers were able to establish ancillary communication methods including telephone and videoconferencing to engage families in goals of care conversations during the pandemic, with no substantial delay in time to first goals of care conversation as compared to prior literature.…”

Factors Associated with Duration of Rehabilitation Among Older Adults with Prolonged Hospitalization

“…This observational cohort study provides novel insights regarding the duration of rehabilitation provided to older adults during a prolonged hospitalization for a range of diagnoses, and highlights large disparities in RD within a large safety‐net hospital that may contribute to differences in clinical and functional outcomes 25,33‐39 . We found that hospitalized older adults received about 1 hour of multidisciplinary rehabilitation per week.…”

Disparities After Discharge: The Association of Limited English Proficiency and Post-Discharge Patient Reported Issues

“…We classified patients as having limited English proficiency (LEP) if in the electronic medical record (EMR), their preferred language for healthcare was a language other than English and if they self-identified as needing an interpreter. This definition was validated through chart review in a prior study conducted at the same institution 3 . In that study, compared to the chart reviewers’ assessment of English proficiency, the definition had a positive predictive value of 100%; thus, any misclassification in this study would err on the side of categorizing patients with LEP as EP.…”

“…1 These barriers are particularly problematic in the hospital, where patients with LEP are more likely to suffer adverse events, have higher mortality rates, and have higher readmission rates than English proficient (EP) patients. 2,3 While prior studies have documented in-hospital adverse events, the experience of patients with LEP during and after hospital discharge is not well understood.…”