By Lisa Rapaport

(Reuters Health) – Poor language comprehension may raise the odds of a repeat hospitalization, a Canadian study suggests.

Researchers in Toronto found that patients with limited English proficiency were more likely than fluent English speakers to be hospitalized more than once in the same month.

They compared 2,336 patients with limited English proficiency and 7,545 patients with solid English skills who were hospitalized at two Toronto hospitals between 2008 and 2016. Patients either had acute conditions, including pneumonia or a broken hip, or long-term problems such as chronic obstructive pulmonary disease (COPD) or heart failure.

Overall, about 15% of patients visited the emergency room within 30 days of leaving the hospital and 12.5% had repeat hospital admissions. After three months, 22% of patients had a repeat hospitalization.

With limited English proficiency, heart failure patients were 32% more likely to visit the ER and 24%-29% more likely to have a readmission. And with COPD, patients with limited English were 32%-51% more likely to have a readmission.

“We think that challenges with communication in hospital and after discharge play a large role in our findings,” said Dr. Shail Rawal, a researcher at the University of Toronto who led the study.

“The care of patients with complex chronic diseases requires clear communication between patients, caregivers, and clinicians during a hospitalization, the transition home, and in the community,” Rawal said by email. “Our study suggests that these requirements may be even greater for patients with limited English proficiency.”

There was no meaningful difference in ER visits or readmissions based on language skills for people who had pneumonia or hip fractures.

Compared to proficient English speakers, patients with limited English proficiency were older, more likely to be women, and had lower income and more chronic health problems, the authors note.

While the study wasn’t designed to prove whether or how language skills might directly impact health outcomes for chronic or acute conditions, it’s possible that recovery from acute illnesses and injuries is less dependent on how well patients understand their treatment, the researchers note in JAMA.

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For example, hip fracture care has a standard treatment protocol at the hospitals in the study, and pneumonia is typically treated with a set duration of antibiotics. So these conditions don’t depend as much as on patients following through with complicated medication regimens or treatment protocols at home compared with chronic conditions.

One limitation of the study is that researchers considered patients to have limited English proficiency if they had a preferred language other than English. It’s possible at least some of these people were fluent in multiple languages.

The researchers also lacked data on illness severity, education levels and health literacy, or how well people can understand medical information.

“All patients, as well as their families, have questions about their care,” said Dr. Martin Zielinski, medical director for research at the Mayo Clinic Adult and Pediatric Trauma Centers in Rochester, Minnesota.

“This doesn’t change no matter the context,” Zielinski, who wasn’t involved in the study, said by email. “What does change, however, is the patient’s comprehension about the answers they were provided or even their willingness to ask their questions.”

Patients who are confused about what happened during their hospital stay, or who don’t understand the treatment they need at home afterwards, are more likely to show up back in the hospital, he said. And lower-income patients, like those in the study with limited English proficiency, might also have difficulty affording prescriptions.

“All of these factors lead to a cycle that can be difficult to get out of, which will prompt further medical evaluations which may have been avoidable otherwise,” Zielinski said.

Getting help from somebody who does speak English well may minimize the risk of misunderstandings.

“Always insist on a medical interpreter,” Zielinski said. “Also, bringing along a family friend or colleague who speaks English fluently, preferably with some medical knowledge, may help alleviate some of the miscommunication issues.”

SOURCE: JAMA, online October 22, 2019.