Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA; National Clinician Scholars Program, University of California, Los Angeles, CA.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA.
Surgery. 2024 Dec;176(6):1711-1720. doi: 10.1016/j.surg.2024.08.016. Epub 2024 Sep 19.
Patients with non-English language preference encounter language barriers across phases of surgical care. Patients with a non-English language preference represent 35% of California households and are disproportionately insured by Medicaid. To determine whether language predicts surgical outcomes, we investigated the association of patient non-English language preference with postoperative emergency department visits and readmissions among California Medicaid enrollees.
Our retrospective analysis of adult Medicaid enrollees undergoing 1 of 10 common inpatient operations using California hospital administrative data (2016-2019) modeled the association between non-English language preference and 30-day postoperative emergency department visits and readmissions using mixed effects logistic regression with hospital random intercept, adjusting for patient, operation, hospital, and community characteristics. Secondary analyses stratified by operation urgency and by insurance type in an all-payor cohort.
Of 115,527 Medicaid enrollees, 17.2% had non-English language preference (n = 19,881), 66% were female (n = 73,653), and 40% were Hispanic/Latino (n = 45,541). Patients with non-English language preference experienced fewer postoperative emergency department visits (non-English language preference: 13.5%, English preference: 17.9%, P < .001) and readmissions (non-English language preference: 7.5%, English preference: 8.5%, P < .001), which persisted in adjusted models (adjusted odds ratio emergency department, 0.80, 95% confidence interval, 0.77-0.85; readmissions: adjusted odds ratio, 0.86, 95% confidence interval, 0.80-0.92). Non-English language preference was associated with fewer emergency department visits after elective (adjusted odds ratio, 0.80; 95% confidence interval, 0.73-0.88) and urgent/emergent surgery (adjusted odds ratio, 0.80; 95% confidence interval, 0.75-0.85) but not readmissions after elective surgery (adjusted odds ratio, 0.89; 95% confidence interval, 0.78-1.01). This pattern was only observed for Medicaid and not other insurance types.
Patients with non-English language preference who receive Medicaid have fewer postoperative emergency department visits and readmissions, even after urgent surgery. Our findings suggest that patterns of health care seeking after surgery vary by patient language, and investigating explanatory mechanisms is needed.
非英语语言偏好的患者在手术护理的各个阶段都会遇到语言障碍。有非英语语言偏好的患者占加利福尼亚州家庭的 35%，并且不成比例地由医疗补助计划承保。为了确定语言是否预测手术结果，我们研究了患者非英语语言偏好与加利福尼亚州医疗补助计划参保者术后 30 天内急诊就诊和再入院之间的关联。
我们使用加利福尼亚州医院管理数据（2016-2019 年）对接受 10 种常见住院手术之一的成年医疗补助计划参保者进行回顾性分析，使用混合效应逻辑回归模型（带有医院随机截距），对非英语语言偏好与术后 30 天内急诊就诊和再入院之间的关联进行建模，调整了患者、手术、医院和社区特征。在所有支付者队列中按手术紧急程度和保险类型进行二次分析。
在 115527 名医疗补助计划参保者中，有 17.2%（n=19881）有非英语语言偏好，66%（n=73653）为女性，40%（n=45541）为西班牙裔/拉丁裔。有非英语语言偏好的患者术后急诊就诊（非英语语言偏好：13.5%，英语语言偏好：17.9%，P<0.001）和再入院（非英语语言偏好：7.5%，英语语言偏好：8.5%，P<0.001）较少，这在调整模型中仍然存在（急诊就诊：调整后的优势比为 0.80，95%置信区间为 0.77-0.85；再入院：调整后的优势比为 0.86，95%置信区间为 0.80-0.92）。非英语语言偏好与择期（调整后的优势比，0.80；95%置信区间，0.73-0.88）和紧急/紧急手术（调整后的优势比，0.80；95%置信区间，0.75-0.85）后的急诊就诊减少有关，但与择期手术后的再入院无关（调整后的优势比，0.89；95%置信区间，0.78-1.01）。这种模式仅在医疗补助计划中观察到，而不是其他保险类型。
接受医疗补助计划的非英语语言偏好患者，即使接受紧急手术，术后急诊就诊和再入院的次数也较少。我们的研究结果表明，术后寻求医疗保健的模式因患者语言而异，需要调查解释机制。
