Ngai Ka Ming, Grudzen Corita R, Lee Roy, Tong Vicky Y, Richardson Lynne D, Fernandez Alicia
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, New York University School of Medicine, New York, NY.
Department of Emergency Medicine, New York University School of Medicine, New York, NY.
Ann Emerg Med. 2016 Aug;68(2):213-21. doi: 10.1016/j.annemergmed.2016.02.042. Epub 2016 Mar 29.
Language barriers are known to negatively affect many health outcomes among limited English proficiency patient populations, but little is known about the quality of care such patients receive in the emergency department (ED). This study seeks to determine whether limited English proficiency patients experience different quality of care than English-speaking patients in the ED, using unplanned revisit within 72 hours as a surrogate quality indicator.
We conducted a retrospective cohort study in an urban adult ED in 2012, with a total of 41,772 patients and 56,821 ED visits. We compared 2,943 limited English proficiency patients with 38,829 English-speaking patients presenting to the ED after excluding patients with psychiatric complaints, altered mental status, and nonverbal states, and those with more than 4 ED visits in 12 months. Two main outcomes-the risk of inpatient admission from the ED and risk of unplanned ED revisit within 72 hours-were measured with odds ratios from generalized estimating equation multivariate models.
Limited English proficiency patients were more likely than English speakers to be admitted (32.0% versus 27.2%; odds ratio [OR]=1.20; 95% confidence interval [CI] 1.11 to 1.30). This association became nonsignificant after adjustments (OR=1.04; 95% CI 0.95 to 1.15). Included in the analysis of ED revisit within 72 hours were 32,857 patients with 45,546 ED visits; 4.2% of all patients (n=1,380) had at least 1 unplanned revisit. Limited English proficiency patients were more likely than English speakers to have an unplanned revisit (5.0% versus 4.1%; OR=1.19; 95% CI 1.02 to 1.45). This association persisted (OR=1.24; 95% CI 1.02 to 1.53) after adjustment for potential confounders, including insurance status.
We found no difference in hospital admission rates between limited English proficiency patients and English-speaking patients. Yet limited English proficiency patients were 24% more likely to have an unplanned ED revisit within 72 hours, with an absolute difference of 0.9%, suggesting challenges in ED quality of care.
已知语言障碍会对英语水平有限的患者群体的诸多健康结局产生负面影响，但对于此类患者在急诊科接受的护理质量却知之甚少。本研究旨在以72小时内的非计划复诊作为替代质量指标，确定英语水平有限的患者在急诊科接受的护理质量是否与说英语的患者不同。
2012年，我们在一家城市成人急诊科进行了一项回顾性队列研究，共有41,772名患者和56,821次急诊科就诊。我们将2,943名英语水平有限的患者与38,829名说英语的患者进行了比较，这些说英语的患者在排除有精神疾病主诉、精神状态改变、非言语状态的患者以及12个月内急诊科就诊超过4次的患者后到急诊科就诊。通过广义估计方程多变量模型的比值比来衡量两个主要结局——从急诊科住院的风险和72小时内非计划复诊的风险。
英语水平有限的患者比说英语的患者更有可能被收治入院（32.0%对27.2%；比值比[OR]=1.20；95%置信区间[CI]为1.11至1.30）。调整后这种关联变得不显著（OR=1.04；95%CI为0.95至1.15）。在对72小时内急诊科复诊的分析中纳入了32,857名患者的45,546次急诊科就诊；所有患者中有4.2%（n=1,380）至少有1次非计划复诊。英语水平有限的患者比说英语的患者更有可能进行非计划复诊（5.0%对4.1%；OR=1.19；95%CI为1.02至1.45）。在对包括保险状况在内的潜在混杂因素进行调整后，这种关联仍然存在（OR=1.24；95%CI为1.02至1.53）。
我们发现英语水平有限的患者和说英语的患者在住院率方面没有差异。然而，英语水平有限的患者在72小时内进行非计划急诊科复诊的可能性要高24%，绝对差异为0.9%，这表明在急诊科护理质量方面存在挑战。
