Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Gen Intern Med. 2018 Dec;33(12):2113-2119. doi: 10.1007/s11606-018-4493-8. Epub 2018 Sep 5.
Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED).
To compare the care processes of LEP patients in the ED.
Retrospective cohort study.
ED in a large tertiary care academic medical center.
Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care.
Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED.
We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03-1.19) and be admitted to the hospital (OR 1.09, CI 1.01-1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73-1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22-1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02-1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70-0.91), but those preferring "other" languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17-1.57).
ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.
在急诊部（ED）这种高度紧张和快节奏的环境中，英语水平有限（LEP）的患者可能特别脆弱。
比较急诊部 LEP 患者的护理流程。
回顾性队列研究。
大型三级保健学术医疗中心的 ED。
2013 年 9 月 1 日至 2015 年 8 月 31 日期间，在 ED 就诊时母语为 LEP 和英语熟练（EP）的成年 LEP 和 EP 患者。LEP 患者是指在登记就诊时选择英语以外的首选语言的患者。
最初从 ED 出院的患者的诊断研究、入院和复诊率。
我们研究了 57435 次就诊，其中 5241 次（9.1%）是 LEP 患者。在调整后的分析中，LEP 患者更有可能接受 X 光/超声检查（比值比 1.11，95%置信区间 1.03-1.19）和住院治疗（比值比 1.09，95%置信区间 1.01-1.19）。72 小时复诊率无差异（比值比 0.98，95%置信区间 0.73-1.33）。以心血管系统相关症状就诊的 LEP 患者更有可能接受应激测试（比值比 1.51，95%置信区间 1.22-1.86），以胃肠道疾病就诊的患者更有可能接受 X 光/超声检查（比值比 1.31，95%置信区间 1.02-1.68）。在分层分析中，西班牙语患者的住院率较低（比值比 0.8，95%置信区间 0.70-0.91），但选择“其他”语言的患者（所有语言的患者数均＜500）的住院调整后率有统计学显著升高（比值比 1.35，95%置信区间 1.17-1.57）。
LEP 患者在 ED 就诊时既增加了诊断检测率，也增加了住院率。需要研究这些差异产生的原因以及它们是否代表护理效率低下。
