Language Barriers and Understanding of Hospital Discharge Instructions

Background: Effective communication at hospital discharge is necessary for an optimal transition and to avoid adverse events. We investigated the association of a language barrier with patient understanding of discharge instructions. Methods: Spanish-speaking, Chinese-speaking, and English-speaking patients admitted to 2 urban hospitals between 2005 and 2008, comparing patient understanding of follow-up appointment type, and medication category and purpose between limited English-proficient (LEP) and English-proficient patients. Results: Of the 308 patients, 203 were LEP. Rates of understanding were low overall for follow-up appointment type (56%) and the 3 medication outcomes (category 48%, purpose 55%, both 41%). In unadjusted analysis, LEP patients were less likely than English-proficient patients to know appointment type (50% vs. 66%; P=0.01), medication category (45% vs. 54%; P=0.05), and medication category and purpose combined (38% vs. 47%; P=0.04), but equally likely to know medication purpose alone. These results persisted in the adjusted models for medication outcomes: LEP patients had lower odds of understanding medication category (odds ratio 0.63; 95% confidence interval, 0.42—0.95); and category/purpose (odds ratio 0.59; 95% confidence interval, 0.39—0.89). Conclusions: Understanding of appointment type and medications after discharge was low, with LEP patients demonstrating worse understanding of medications. System interventions to improve communication at hospital discharge for all patients, and especially those with LEP, are needed.