Language Discordance Increases Risk of Hospital Readmissions
Clinical question: Does language discordance increase hospital readmissions or unplanned emergency department (ED) visits?
Background: Studies have shown that language discordance impacts patient-clinician communication and patient ease of accessing care, but it is unclear whether language discordance impacts readmissions or ED revisits.
Study design: Systematic review and meta-analysis
Setting: Hospitals and EDs in the U.S., Australia, Canada, and Switzerland
Synopsis: This article sought to determine whether patient-clinician language discordance increases the risk of unplanned hospital readmission or ED revisits. A total of 49 studies were included, and the majority were observational studies looking at hospitalized adult patients from the general medicine service. They found that adult patients with a non-dominant language preference had an increased odds of 28 or 30-day hospital readmissions (OR, 1.11 [95% CI, 1.04-1.18]) and 30-day ED revisits (OR, 1.07 [95% CI, 1-1.15]). For pediatric patients where the parent was identified as having a non-dominant language preference, they found a higher rate of 72-hour ED revisits (OR, 1.12 [95% CI, 1.05-1.19]) and seven-day ED revisits (OR, 1.02 [95% CI, 1.01-1.03]). Only two studies looked at the use of interpretation services and found no difference in readmission rates when interpreters were used. The studies were somewhat heterogeneous in terms of study design, language discordance definition, inclusion criteria, and outcome timing. Additionally, there was limited literature looking at the impact of language access interventions, such as interpretation services, on clinical outcomes.
Bottom line: Language discordance between clinicians and patients is associated with higher odds of readmission or ED revisit and additional studies are needed to see if using interpretation services has an impact on clinical outcomes.
Citation: Chu JN, et al. Association between language discordance and unplanned hospital readmissions or emergency department revisits: a systematic review and meta-analysis. BMJ Qual Saf. 2024;33(7):456-469. doi:10.1136/bmjqs-2023-016295.
Dr. Shi is an assistant clinical professor and the director of student-run clinics at the University of California Davis School of Medicine in Sacramento, Calif.