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

Importance: Patients with limited English proficiency (LEP) experience worse outcomes following hospital discharge. Care transition programs are common, yet little known about the disparities in quality (process and outcome measures) experienced by patients with LEP. Objective: To determine the association of LEP and care transition quality Design: A retrospective cohort study, from May 1, 2018, to April 30, 2019 Setting: A population health program within an urban, academic medical center. The care transition program used multilingual, automated telephonic outreach to assess patient-reported issues three days post discharge. Participants: All adults discharged home from the hospital during the study period who were not part of a bundled payments program Exposure: Limited English proficiency Main outcomes: Process measures (reach rate, time to address patient reported issue) and outcome measures (discharge instructions questions, difficulty obtaining prescriptions, medication concerns, follow up care questions, new or worsening symptoms, any other clinical issues). Results: 13,860 patients were included in the study; 11% had LEP. The program reached most patients regardless of LEP status but was less likely to reach patients with LEP (average marginal effect [AME] 3.3%; 95% CI, 1.4% to 5.1%). After adjustment, patients with LEP reported high rates of all measured patient-reported outcomes: discharge instruction (AME 4.8%; 95% CI, 2.7% to 6.9%), obtaining prescriptions (AME 2.9%; 95% CI, 0.6% to 5.1%), medications concerns (AME 2.3%; 95% CI, 0.0% to 4.6%), follow up questions (AME 2.8%; 95% CI, 0.3% to 5.3%), new or worsening symptoms (AME 3.2%; 95% CI, 0.7% to 5.8%), and any other clinical issues (AME 3.6%; 95% CI, 1.1% to 6.1%). When issues were identified, the association between LEP and time to resolution of an issue was statistically, but not clinically, significant. Conclusion and Relevance: Among patients with LEP, substantial disparities exist in patient-reported post-discharge outcome measures indicating a need for better discharge processes that focus on quality and health equity. Following discharge, relatively minor disparities were observed in the processes of a care transitions program that supports non-English languages.