Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 759, Baltimore, MD, 21205, USA.
J Gen Intern Med. 2022 Jun;37(8):2050-2061. doi: 10.1007/s11606-021-07348-6. Epub 2022 Feb 2.
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.
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.
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.
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.
CRD42020143477.
在住院患者中，英语水平有限（LEP）较为常见，可能会影响医疗护理。我们对比较住院患者中英语熟练（EP）与 LEP 患者的临床转归的文献进行了综合分析。
本系统综述在数据库建立之初至 2020 年 6 月 7 日，通过 PubMed、Embase 和 Web of Science 进行检索，以确定对接受医院基础护理（在急诊室、住院病房、外科/程序套房或重症监护病房）的患者进行研究的文献，这些研究将 LEP 患者与 EP 组进行了比较。我们评估了死亡率、住院时间（LOS）、再入院/再就诊率和并发症。使用纽卡斯尔-渥太华量表评估研究质量。
26 项研究符合入选标准。研究环境和人群存在异质性。主要语言的确定方式也存在差异；大多数研究（16/26）直接或通过医院记录使用患者的自我报告。在 16 项研究中，有 13 项研究发现 LEP 与全因死亡率之间无显著关联。在 17 项研究中，有 9 项研究未发现 LOS 存在差异，4 项研究发现 LOS 较长，3 项研究发现 LOS 较短，1 项研究的 LOS 结果在 LEP 患者中存在混合结果。一些研究表明，在医院层面可能存在 LOS 差异的中介因素。有 9 项研究评估了住院患者的再入院情况。在患有慢性疾病（如心力衰竭）的患者中，存在 LEP 患者再入院增加的证据，但在接受手术/程序或患有急性疾病的患者中，没有证据表明再入院增加。有 5 项研究评估了与住院相关的并发症或伤害，在语言组之间未发现差异。
研究界缺乏对 LEP 的标准化定义。大多数研究未发现英语水平与死亡率或并发症之间存在关联。LOS 的发现结果不一，可能受医院层面的影响。语言造成的再入院差异主要集中在慢性疾病中。鉴于研究 LEP 人群的研究很少，因此急需开展更多研究。
PROSPERO 注册号：CRD42020143477。
