Immigrants comprise 13% of the US population and 25.2 million US residents are categorized as having limited English speaking skills, defined as the inability to understand healthcare communication in English. The number of limited English proficiency (LEP) individuals living in the US grew 80% between 1990 and 2010 and they represent 10% or more of the populations in the 13 most highly populous states. As a result, healthcare workers in the US are more likely than ever to regularly encounter LEP patients in their practice. Language barriers likely pose a particularly vexing problem for the complex care coordination processes that occur when patients transition from the hospital to home care, representing an understudied problem. We know that LEP status increases a patient's risk for readmission between 15 and 25% and that there are effective means for reducing these barriers, e.g. adequate interpreter services. Yet there is a critical gap in our understanding of how language barriers impact the transition to home healthcare and the personnel, patient, and organizational factors that might influence post-acute discharge outcomes in LEP patients. Our overall goal is to understand how language barriers impact 30-day rehospitalization and home healthcare resource utilization among LEP patients recently discharged from the hospital, with a secondary aim of understanding their impact on functional status. We will accomplish this goal by conducting a mixed methods study in partnership with The Visiting Nurse Service of New York (VNSNY), which documents the language skills and abilities of its employees and patients thereby allowing us to identify linguistically concordant visits in its extensive database of over million LEP patient visits coming from 86,000 clients, with four language groups (Spanish, Korean, Russian, Chinese). This unique but nationally representative dataset and the New York City location of the study offers an appropriate environment to study this problem. To the best of our knowledge, this study will be the largest and most diverse study of the influence of language barriers on critical clinical patient outcomes in the US. Results from this study will have policy and research implications for the organization and management of care coordination for LEP patients. This study will complement existing initiatives at the Agency for Healthcare Research and Quality focused on improving patient-provider communication for LEP patient populations, reducing racial and ethnic health disparities, improving care for vulnerable populations, improving post-hospital discharge processes, and addressing patient safety across the healthcare system.
One fifth of households in the United States speak a language other than English at home. By examining the associations between patient-provider language concordance, interpreter use, and post-acute care outcomes in the home healthcare setting along with ascertaining the dynamics of systemic care coordination issues, we can ensure that patients with a language barrier do not have their health outcomes adversely affected after a hospitalization episode. This will be the largest study of the impact of the healthcare system on LEP patient outcomes, including re-hospitalization, with implications that will make a major impact on US health services.
| Squires, Allison (2018) Strategies for overcoming language barriers in healthcare. Nurs Manage 49:20-27 |
| Squires, Allison (2017) Evidence-based approaches to breaking down language barriers. Nursing 47:34-40 |
