The Language of Health

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For certain conditions, patients with limited English proficiency may be readmitted more often.
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Hospitals conduct what is known as ‘discharge planning’ to ensure that patients, once released from the hospital, continue to receive the care they need to stay healthy and avoid being readmitted.

The language of health, disease and wellness—which comes with its own vocabulary—can seem like a foreign language to many patients. However, for those with limited English proficiency who are admitted to anglophone hospitals, the barriers to understanding may be so great that health outcomes may be affected.

This was the key finding of a study published in The Journal of the American Medical Association.

A team of UHN researchers led by Drs. Shail Rawal, George Tomlinson and Angela Cheung, Senior Scientist at the Toronto General Hospital Research Institute, found that patients admitted for exacerbations of chronic diseases, such as heart failure and chronic obstructive pulmonary disease (COPD), with limited English proficiency were more likely to be readmitted to the emergency department than those who were proficient in English.

Specifically, for heart failure patients, around 22% of those with limited English proficiency were readmitted to the emergency department within 30 days of discharge, while only 15% of those who were proficient in English were readmitted. The study included over 9000 patients that were admitted for chronic conditions at the Toronto General Hospital or the Toronto Western Hospital.

While previous findings have found that English proficiency does not affect hospital readmission rates for patients admitted for acute conditions such as hip fracture, pneumonia or acute heart attack, the current study reveals that this may not be the case for all diseases.

“The demands on patients with chronic heart failure and COPD are high. Upon discharge, they are required to follow detailed instructions, manage medication regimens and oversee transitions in their care between different providers,” says Dr. Cheung “Chronic heart failure and COPD may be more communication sensitive than other conditions that have simpler treatment plans.”

While preliminary, these findings suggest that certain health conditions may require more rigorous communication strategies and support after discharge to ensure equal access to care.

This work was supported by the HoPingKong Centre for Excellence in Education and Practice, and the Toronto General & Western Hospital Foundation. AM Cheung is the KY and Betty Ho Chair in Integrative Medicine and a Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health.

Rawal S, Srighanthan J, Vasantharoopan A, Hu H, Tomlinson G, Cheung AM. Association Between Limited English Proficiency and Revisits and Readmissions After Hospitalization for Patients With Acute and Chronic Conditions in Toronto, Ontario, Canada. JAMA. 2019 Oct 22;322(16):1605-1607. doi:10.1001/jama.2019.13066.