Disparities After Discharge: The Association of Limited English Proficiency and Postdischarge Patient-Reported Issues

Background: The transition from hospital to home is a vulnerable period for all patients, particularly for those who have limited English proficiency (LEP).

Methods: The research team retrospectively studied adults discharged home from a hospital in 2018-2019 to determine the association of LEP with (1) reach of a care transitions outreach program phone call (automated call within three days after discharge or a subsequent manual phone call) and (2) postdischarge issues reported on the phone calls. All results were adjusted for measured confounders; associations using predicted probabilities and average marginal effects were described.

Results: A total of 13,860 patients were included, and 11.3% had LEP. After adjustment, the program reached most patients regardless of LEP status; automated calls were more likely to reach English proficient patients (81.1% vs. 75.6%, p < 0.01), and when the automated call was unsuccessful, manual calls were more likely to reach LEP patients (47.8% vs. 28.3%, p < 0.001). After adjustment, patients with LEP reported more difficulty with all measured issues: understanding discharge instructions (11.3% vs. 6.5%), obtaining prescriptions (8.3% vs. 5.5%), medication concerns (12.9% vs. 10.6%), follow-up questions (16.1% vs. 13.3%), new or worsening symptoms (15.1% vs. 11.9%), and any other clinical issues (16.6% vs. 13.0%); p < 0.05 for all comparisons.

Conclusion: Although reach was high for the care transitions program, among patients with LEP, important disparities exist in patient-reported postdischarge issues. These results indicate the need for better discharge processes that focus on communication quality and health equity.