A June 2024 meta-analysis paper published in the BMJ Quality & Safety Journal was brought back to the virtual front pages by Dr. Lucy Shi, who wrote an article about it for The Hospitalist. The paper is a review of research conducted by Chu et al and centered on the association between language discordance and unplanned hospital or emergency department (ED) readmissions.
The researchers also explored the impact of interpretation services on disparities in these outcomes between patients with and without non-dominant language preferences. They used as the basis for their analysis a search for publications on PubMed, Embase and Google Scholar first conducted on 21 January 2021 and updated on 27 October 2022.
As has been extensively documented, patients and families with non-dominant language preferences often report difficulties in communicating, understanding medical information, and accessing healthcare services. Language discordance may contribute to adverse events and poorer outcomes during care transitions, such as hospital discharge.
The paper authors acknowledge that prior research on the impact of language discordance on hospital readmissions and ED revisits has yielded conflicting results, which they partly attributed to differences in research criteria.
The studies included in the meta-analysis were primarily based in Switzerland and in several English-speaking countries (the US, Australia, and Canada), and contained data on patient or parental language skills/preference as well as an unplanned hospital readmission or ED revisit as an outcome.
The authors excluded non-English research, studies lacking primary data, and those that did not stratify patient outcomes by language or interpretation service use. In total, the data covered 18 adult studies for 28-day or 30-day hospital readmission; seven adult studies for 30-day ED revisits; and five pediatric studies for 72-hour or seven-day ED revisits.
Findings
The meta-analysis found that “language discordant adult patients had increased odds of hospital readmissions.” According to the authors, their data analysis yielded a statistically significant increase (full table: OR 1.11, 95% CI 1.04 to 1.18) in the likelihood of readmission within 28 or 30 days for adults with a non-dominant language preference.
Notably, when studies were stratified by the provision of interpretation services, the results differed significantly. “Among the four studies that verified interpretation services for language discordant patient-clinician interactions, there was no difference in readmission… While studies that did not specify interpretation service access/use found higher odds of readmission.”
Adult patients with a non-dominant language preference also had higher odds of readmission into the ED compared with adults with a dominant language preference; more specifically, a statistically significant higher chance of unplanned ED readmissions within 30 days for language-discordant adults.
Conversely, increased odds of readmission were not observed in adult studies where interpretation services were verified. The authors concluded that “providing interpretation services may mitigate the impact of language discordance and reduce hospital readmissions among adult patients.”
For pediatric patients, the meta-analysis revealed that children of parents who were language discordant with providers had higher odds of readmission to the ED at 72 hours and seven days compared with patients whose parents spoke the dominant language fluently.
However, the authors clarified that a meta-analysis for pediatric hospital readmissions was not conducted due to a limited number of studies and divergent research criteria, and that individual studies that were reviewed did not show statistically significant results.
The study underscores the limitations in the current evidence base, particularly regarding pediatric readmissions and the impact of language access interventions on clinical outcomes. The differences in how language discordance is defined and measured across studies is noted as a limitation as well.
The authors recommend a “more uniform approach to identifying patients who experience language discordance-related barriers to healthcare and whose specific language preferences (eg, a patient vs a parent) is most impactful on clinical outcomes.”