ORIGINAL RESEARCH Influence of Language Barriers on Outcomes of Hospital Care for General Medicine Inpatients Leah S. Karliner, MD, MAS 1,2 Sue E. Kim, PhD, MPH 1,2,5 David O. Meltzer, MD, PhD 3 Andrew D. Auerbach, MD, MPH 1,4 1 Department of Medicine, University of California at San Francisco, San Francisco, California. 2 Medical Effectiveness Research Center for Diverse Populations, Division of General Internal Medicine, University of California at San Francisco, San Francisco, California. 3 Department of Medicine, The Harris School for Public Policy and the Department of Economics, University of Chicago, Chicago, Illinois. 4 Division of Hospital Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California. 5 Health and Barriers to Employment, Department of MDRC, California Office, Oakland, California. This research was supported by a grant from the University of California, San Francisco Medical Center (UCSF) Academic Senate Research Evaluation and Allocation Committee. The Multicenter Hospitalist Study was supported by grant R01 HS10597 AHRQ from the Agency for Healthcare Research and Quality, and was registered at Clinicaltrials.gov: NCT00204048. Dr. Karliner is supported by a Mentored Research Scholar Grant (MRSG-060253-01) from the American Cancer Society. Dr. Auerbach is supported by a K08 research and training grant (K08 HS11416-02) from the Agency for Healthcare Research and Quality. The authors are unaware of any conflict of interest related to this study. BACKGROUND: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency. OBJECTIVE: To examine whether patients’ primary language influences hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non- English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. V C 2010 Society of Hospital Medicine. KEYWORDS: communication, continuity of care transition and discharge planning, quality improvement. Forty-five-million Americans speak a language other than English and more than 19 million of these speak English less than very well—or are limited English proficient (LEP). 1 The number of non-English-speaking and LEP people in the US has risen in recent decades, presenting a challenge to healthcare systems to provide high-quality, patient-centered care for these patients. 2 For outpatients, language barriers are a fundamental con- tributor to gaps in health care. In the clinic setting, patients who do not speak English well have less access to a usual source of care and lower rates of physician visits and preven- tive services. 3–6 Even when patients with language barriers do have access to care, they have poorer adherence, decreased comprehension of their diagnoses, decreased satisfaction with care, and increased medication complications. 7–10 Few studies, however, have examined how language influences outcomes of hospital care. Compared to English- speakers, patients who do not speak English well may expe- rience longer lengths of stay, 11 and have more adverse events while in the hospital. 12 However, these previous stud- ies have not investigated outcomes immediately post-hospi- talization, such as readmission rates and mortality, nor have they directly addressed the interaction between ethnicity and language. To understand these questions, we analyzed data col- lected from a university-based teaching hospital which cares 2010 Society of Hospital Medicine DOI 10.1002/jhm.658 Published online in wiley InterScience (www.interscience.wiley.com). 276 Journal of Hospital Medicine Vol 5 No 5 May/June 2010