Clinical Chief, Hospital Medicine Boston Children's Hospital Boston Children's Hospital/Harvard Medical School Boston, Massachusetts, United States
Background: Language barriers for patients with limited English proficiency (LEP) contribute to disparities in health outcomes. Little is known about interpreter use during inpatient hospital stays or its association with health outcomes.
Objective: To understand how interpreters are used for LEP patients during hospitalization and to analyze whether LEP status and interpreter use are associated with readmission and revisit rates.
Design/Methods: A retrospective analysis of patients <18 years hospitalized from 1/1-3/31/19 at a free-standing children’s hospital. We defined LEP status as patients with a non-English primary language or interpreter need; all others were English proficient (EP). We compared outcomes among 3 groups: LEP patients who used interpreters (LEP+), LEP patients who never used interpreters (LEP-) and EP patients. Among LEP+, 2 modes of interpreters (in-person only [I-only] vs video +/- in-person [V/I]) were examined. Interpreter use on the day of discharge was analyzed. Outcomes of interest were 30-day readmission and revisit (readmission and emergency room visit) rates.
Results: Of the 4,238 admissions, 14.6% were LEP patients (43.4% were LEP+). In comparison to EP patients, LEP+ and LEP- patients were more likely to be Hispanic, be medically complex, and have public or international insurance (Table 1). Overall, in comparison to EP patients, LEP patients had significantly higher readmission (9.3% vs 6.6%, p=.013) and revisit (18.1% vs 10.6%, p<.001) rates. Readmission rate of LEP+ patients with V/I interpreters was significantly higher than that of EP patients (13.1% vs 6.6%, p<.001; Table 2). Revisit rate was higher among LEP patients with I-only interpreters (18.9%, p=.016) and V/I interpreters (23.3%, p<.001) in comparison to EP patients (11.0%). On the day of discharge, 36.7% of LEP+ patients had no record of interpreter use (Table 3). Readmission rate of LEP+ patients who used interpreters at discharge was significantly higher than that of EP patients (12.2% vs 6.6%, p=.002). Revisit rate of LEP+ patients who used interpreters (20.3%, p<.001) or did not use interpreters at discharge (25.7%, p<.001) and LEP- patients (15.3%, p=.008) was significantly higher than that of EP patients (11.0%). Conclusion(s): Patterns of interpreter use for LEP patients vary based on race/ethnicity, medical complexity, and insurance. Readmission and revisit rates are higher generally for LEP patients. Using in-person interpreters on the day of discharge may reduce readmission and revisit rates of LEP patients.
Table 1. Child Descriptive Characteristics
Table 2. Readmission and revisit rates by interpreter mode among LEP+ patients
Table 3. Readmission and revisit rates, Interpreter use at discharge
Authors/Institutions: Amanda Growdon, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, United States; Jonathan Hatoun, Boston Children's Hospital/Pediatric Physicians' Organization at Children's/Harvard Medical School, Boston, Massachusetts, United States; Shanshan Liu, Boston Children's Hospital, Boston, Massachusetts, United States; Sarah Lee, Boston Children's Hospital, Boston, Massachusetts, United States; Herminia Shermont, Boston Children's Hospital, Boston, Massachusetts, United States; Sara W. Buscher, Boston Children's Hospital, Boston, Massachusetts, United States; Tasnim H. Mollah, Boston Children's Hospital, Boston, Massachusetts, United States; Sara L. Toomey, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, United States
