BACKGROUND: Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. OBJECTIVE: To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. DESIGN: Natural experiment on a medicine floor of an academic hospital. PARTICIPANTS: Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. EXPOSURE: Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. OUTCOME MEASURES: Thirty-day readmission, length of stay, estimated hospital expenditures. RESULTS: Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. CONCLUSIONS: Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.
BACKGROUND: Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. OBJECTIVE: To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. DESIGN: Natural experiment on a medicine floor of an academic hospital. PARTICIPANTS: Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. EXPOSURE: Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. OUTCOME MEASURES: Thirty-day readmission, length of stay, estimated hospital expenditures. RESULTS: Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. CONCLUSIONS: Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.
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