Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review
Background Limited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients. Methods This systematic review searched PubMed, Embase, and Web of...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2022-06, Vol.37 (8), p.2050-2061 |
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| creator | Woods, Alison P. Alonso, Andrea Duraiswamy, Swetha Ceraolo, Carl Feeney, Timothy Gunn, Christine M. Burns, William R. Segev, Dorry L. Drake, F. Thurston |
| description | Background
Limited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients.
Methods
This systematic review searched PubMed, Embase, and Web of Science from database inception through June 7, 2020, to identify research investigating clinical outcomes in patients receiving hospital-based care (in the emergency department, inpatient ward, surgical/procedural suite, or intensive care unit) that compared patients with LEP to an EP group. We assessed mortality, length of stay (LOS), readmissions/revisits, and complications. Study quality was evaluated using the Newcastle-Ottawa Scale.
Results
Twenty-six studies met eligibility criteria. Study settings and populations were heterogeneous. Determination of primary language varied; a majority of studies (16/26) used patient self-report directly or via hospital records. Of 16 studies examining LEP and all-cause mortality, 13 found no significant association. Of 17 studies measuring LOS, 9 found no difference, 4 found longer LOS, 3 found shorter LOS, and 1 had mixed LOS results among patients with LEP. Several investigations suggested that LOS differences may be mediated at the hospital level. Nine studies evaluated inpatient readmissions. Among patients with LEP, there was evidence for increased readmissions in the setting of chronic medical conditions such as heart failure, but no evidence for increased readmissions among cohorts undergoing surgeries/procedures or with acute medical conditions. Five studies evaluated complications or harm related to a hospitalization, and no differences were found between language groups.
Discussion
The research community lacks a standardized definition of LEP. Most studies did not find an association between English proficiency and mortality or complications. LOS findings were mixed and may be influenced at the hospital level. Differences in readmissions by language were concentrated in chronic medical conditions. Given the paucity of studies examining LEP populations, additional research is imperative.
Prospero Registration Number
CRD42020143477 |
| doi_str_mv | 10.1007/s11606-021-07348-6 |
| format | Article |
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Limited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients.
Methods
This systematic review searched PubMed, Embase, and Web of Science from database inception through June 7, 2020, to identify research investigating clinical outcomes in patients receiving hospital-based care (in the emergency department, inpatient ward, surgical/procedural suite, or intensive care unit) that compared patients with LEP to an EP group. We assessed mortality, length of stay (LOS), readmissions/revisits, and complications. Study quality was evaluated using the Newcastle-Ottawa Scale.
Results
Twenty-six studies met eligibility criteria. Study settings and populations were heterogeneous. Determination of primary language varied; a majority of studies (16/26) used patient self-report directly or via hospital records. Of 16 studies examining LEP and all-cause mortality, 13 found no significant association. Of 17 studies measuring LOS, 9 found no difference, 4 found longer LOS, 3 found shorter LOS, and 1 had mixed LOS results among patients with LEP. Several investigations suggested that LOS differences may be mediated at the hospital level. Nine studies evaluated inpatient readmissions. Among patients with LEP, there was evidence for increased readmissions in the setting of chronic medical conditions such as heart failure, but no evidence for increased readmissions among cohorts undergoing surgeries/procedures or with acute medical conditions. Five studies evaluated complications or harm related to a hospitalization, and no differences were found between language groups.
Discussion
The research community lacks a standardized definition of LEP. Most studies did not find an association between English proficiency and mortality or complications. LOS findings were mixed and may be influenced at the hospital level. Differences in readmissions by language were concentrated in chronic medical conditions. Given the paucity of studies examining LEP populations, additional research is imperative.
Prospero Registration Number
CRD42020143477</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-021-07348-6</identifier><identifier>PMID: 35112283</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Clinical outcomes ; Communication Barriers ; Complications ; Congestive heart failure ; Emergency medical care ; Emergency medical services ; Emergency procedures ; Evaluation ; Hospitals ; Humans ; Internal Medicine ; Language ; Length of Stay ; Limited English Proficiency ; Medical research ; Medicine ; Medicine & Public Health ; Mortality ; Patients ; Population studies ; Populations ; Systematic Review</subject><ispartof>Journal of general internal medicine : JGIM, 2022-06, Vol.37 (8), p.2050-2061</ispartof><rights>The Author(s) under exclusive licence to Society of General Internal Medicine 2022</rights><rights>2022. The Author(s) under exclusive licence to Society of General Internal Medicine.</rights><rights>The Author(s) under exclusive licence to Society of General Internal Medicine 2022.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-2a17e0d8318ec17a9c3d72d6e4efd11800e6b6fdb9c1ee8527a875455672768b3</citedby><cites>FETCH-LOGICAL-c474t-2a17e0d8318ec17a9c3d72d6e4efd11800e6b6fdb9c1ee8527a875455672768b3</cites><orcidid>0000-0002-6968-8312</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198156/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198156/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35112283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Woods, Alison P.</creatorcontrib><creatorcontrib>Alonso, Andrea</creatorcontrib><creatorcontrib>Duraiswamy, Swetha</creatorcontrib><creatorcontrib>Ceraolo, Carl</creatorcontrib><creatorcontrib>Feeney, Timothy</creatorcontrib><creatorcontrib>Gunn, Christine M.</creatorcontrib><creatorcontrib>Burns, William R.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Drake, F. Thurston</creatorcontrib><title>Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Limited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients.
Methods
This systematic review searched PubMed, Embase, and Web of Science from database inception through June 7, 2020, to identify research investigating clinical outcomes in patients receiving hospital-based care (in the emergency department, inpatient ward, surgical/procedural suite, or intensive care unit) that compared patients with LEP to an EP group. We assessed mortality, length of stay (LOS), readmissions/revisits, and complications. Study quality was evaluated using the Newcastle-Ottawa Scale.
Results
Twenty-six studies met eligibility criteria. Study settings and populations were heterogeneous. Determination of primary language varied; a majority of studies (16/26) used patient self-report directly or via hospital records. Of 16 studies examining LEP and all-cause mortality, 13 found no significant association. Of 17 studies measuring LOS, 9 found no difference, 4 found longer LOS, 3 found shorter LOS, and 1 had mixed LOS results among patients with LEP. Several investigations suggested that LOS differences may be mediated at the hospital level. Nine studies evaluated inpatient readmissions. Among patients with LEP, there was evidence for increased readmissions in the setting of chronic medical conditions such as heart failure, but no evidence for increased readmissions among cohorts undergoing surgeries/procedures or with acute medical conditions. Five studies evaluated complications or harm related to a hospitalization, and no differences were found between language groups.
Discussion
The research community lacks a standardized definition of LEP. Most studies did not find an association between English proficiency and mortality or complications. LOS findings were mixed and may be influenced at the hospital level. Differences in readmissions by language were concentrated in chronic medical conditions. Given the paucity of studies examining LEP populations, additional research is imperative.
Prospero Registration Number
CRD42020143477</description><subject>Clinical outcomes</subject><subject>Communication Barriers</subject><subject>Complications</subject><subject>Congestive heart failure</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency procedures</subject><subject>Evaluation</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Language</subject><subject>Length of Stay</subject><subject>Limited English Proficiency</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Patients</subject><subject>Population studies</subject><subject>Populations</subject><subject>Systematic Review</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU9v1DAQxS0EotvCF-CALHHhYvA4ie1wQCqrQpFWKqJwtrzOZOuS2IudFO2lnx2XbcufAydber9580aPkGfAXwHn6nUGkFwyLoBxVdWayQdkAY1oGNStekgWXOua6SIdkMOcLzmHSgj9mBxUDUD5VQtyvfKjn7CjJ2Ez-HxBP6XYe-cxuB21oaPLwQfv7EDP5snFETM97idM9DTmrZ_swN7ZXMaXNiH14c6GnW_RfvNhQ5dxDlPymN9QS893ecLRTt7Rz3jl8ccT8qi3Q8ant-8R-fr-5MvylK3OPnxcHq-Yq1U9MWFBIe90BRodKNu6qlOik1hj3wFozlGuZd-tWweIuhHKatXUTSOVUFKvqyPydu-7ndcjdg5LJjuYbfKjTTsTrTd_K8FfmE28Mi20GhpZDF7eGqT4fcY8mdFnh8NgA8Y5GyFF2QpK8YK--Ae9jHMK5bxCKVm1utV1ocSecinmnLC_DwPc3NRr9vWaUq_5Va-5SfH8zzPuR-76LEC1B3KRwgbT793_sf0JZVaxvA</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Woods, Alison P.</creator><creator>Alonso, Andrea</creator><creator>Duraiswamy, Swetha</creator><creator>Ceraolo, Carl</creator><creator>Feeney, Timothy</creator><creator>Gunn, Christine M.</creator><creator>Burns, William R.</creator><creator>Segev, Dorry L.</creator><creator>Drake, F. Thurston</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6968-8312</orcidid></search><sort><creationdate>20220601</creationdate><title>Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review</title><author>Woods, Alison P. ; Alonso, Andrea ; Duraiswamy, Swetha ; Ceraolo, Carl ; Feeney, Timothy ; Gunn, Christine M. ; Burns, William R. ; Segev, Dorry L. ; Drake, F. Thurston</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-2a17e0d8318ec17a9c3d72d6e4efd11800e6b6fdb9c1ee8527a875455672768b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Clinical outcomes</topic><topic>Communication Barriers</topic><topic>Complications</topic><topic>Congestive heart failure</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency procedures</topic><topic>Evaluation</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Language</topic><topic>Length of Stay</topic><topic>Limited English Proficiency</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Patients</topic><topic>Population studies</topic><topic>Populations</topic><topic>Systematic Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Woods, Alison P.</creatorcontrib><creatorcontrib>Alonso, Andrea</creatorcontrib><creatorcontrib>Duraiswamy, Swetha</creatorcontrib><creatorcontrib>Ceraolo, Carl</creatorcontrib><creatorcontrib>Feeney, Timothy</creatorcontrib><creatorcontrib>Gunn, Christine M.</creatorcontrib><creatorcontrib>Burns, William R.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Drake, F. 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Thurston</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>37</volume><issue>8</issue><spage>2050</spage><epage>2061</epage><pages>2050-2061</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Limited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients.
Methods
This systematic review searched PubMed, Embase, and Web of Science from database inception through June 7, 2020, to identify research investigating clinical outcomes in patients receiving hospital-based care (in the emergency department, inpatient ward, surgical/procedural suite, or intensive care unit) that compared patients with LEP to an EP group. We assessed mortality, length of stay (LOS), readmissions/revisits, and complications. Study quality was evaluated using the Newcastle-Ottawa Scale.
Results
Twenty-six studies met eligibility criteria. Study settings and populations were heterogeneous. Determination of primary language varied; a majority of studies (16/26) used patient self-report directly or via hospital records. Of 16 studies examining LEP and all-cause mortality, 13 found no significant association. Of 17 studies measuring LOS, 9 found no difference, 4 found longer LOS, 3 found shorter LOS, and 1 had mixed LOS results among patients with LEP. Several investigations suggested that LOS differences may be mediated at the hospital level. Nine studies evaluated inpatient readmissions. Among patients with LEP, there was evidence for increased readmissions in the setting of chronic medical conditions such as heart failure, but no evidence for increased readmissions among cohorts undergoing surgeries/procedures or with acute medical conditions. Five studies evaluated complications or harm related to a hospitalization, and no differences were found between language groups.
Discussion
The research community lacks a standardized definition of LEP. Most studies did not find an association between English proficiency and mortality or complications. LOS findings were mixed and may be influenced at the hospital level. Differences in readmissions by language were concentrated in chronic medical conditions. Given the paucity of studies examining LEP populations, additional research is imperative.
Prospero Registration Number
CRD42020143477</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>35112283</pmid><doi>10.1007/s11606-021-07348-6</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6968-8312</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; SpringerLink Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Clinical outcomes Communication Barriers Complications Congestive heart failure Emergency medical care Emergency medical services Emergency procedures Evaluation Hospitals Humans Internal Medicine Language Length of Stay Limited English Proficiency Medical research Medicine Medicine & Public Health Mortality Patients Population studies Populations Systematic Review |
| title | Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review |
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