A June 2024 meta-analysis published in BMJ Quality & Safety was recently brought back into the spotlight by Dr. Lucy Shi, who discussed its findings in an article for The Hospitalist. The study, conducted by Chu et al., examined the link between language discordance and unplanned hospital or emergency department (ED) readmissions.
The researchers also evaluated whether interpretation services could help reduce disparities in these outcomes between patients who speak a non-dominant language and those who do not. Their analysis was based on a literature search of PubMed, Embase, and Google Scholar, initially conducted on January 21, 2021, and updated on October 27, 2022.
Extensive research has shown that patients and families with non-dominant language preferences often face challenges in communication, understanding medical information, and accessing care. Language discordance can contribute to adverse events and poorer outcomes during critical care transitions, such as hospital discharge.
The authors of the paper note that previous research on the effects of language discordance on hospital readmissions and emergency department (ED) revisits has produced mixed results — differences they partially attribute to variations in study criteria and methodologies.
The studies included in the meta-analysis were primarily conducted in Switzerland and English-speaking countries such as the the US, Australia, and Canada. These studies reported data on patient or parental language skills or preferences and measured outcomes such as unplanned hospital readmissions or ED revisits.
To maintain consistency, the authors excluded non-English studies, those lacking primary data, and studies that did not stratify patient outcomes by language preference or use of interpretation services. Ultimately, the analysis included data from 18 adult studies focused on 28- or 30-day hospital readmissions, seven adult studies on 30-day ED revisits, and five pediatric studies examining 72-hour or seven-day ED revisits.
Findings
The meta-analysis revealed that adult patients with language discordance had higher odds of hospital readmission. Specifically, the data showed a statistically significant increase in 28- or 30-day readmission rates for adults with a non-dominant language preference (OR 1.11; 95% CI: 1.04 to 1.18).
Importantly, the impact of interpretation services was notable. In the four studies that confirmed the use of interpretation services during patient-clinician interactions, there was no significant difference in readmission rates. In contrast, studies that did not specify whether interpretation services were provided showed higher odds of readmission for language-discordant patients.
Adult patients with a non-dominant language preference also faced higher odds of emergency department (ED) readmission compared to those who spoke the dominant language. Specifically, the meta-analysis found a statistically significant increase in unplanned ED visits within 30 days among language-discordant adults.
However, this trend was not observed in studies where the use of interpretation services was verified. The authors concluded that “providing interpretation services may mitigate the impact of language discordance and reduce hospital readmissions among adult patients.”
For pediatric patients, the analysis indicated that children whose parents were language-discordant with providers had higher odds of ED readmission within 72 hours and seven days, compared to children whose parents spoke the dominant language fluently.
That said, the authors noted that a meta-analysis for pediatric hospital readmissions was not conducted due to the limited number of studies and inconsistencies in study design. The individual pediatric studies reviewed did not yield statistically significant results.
The study highlights key limitations in the current evidence base — particularly regarding pediatric readmissions and the effectiveness of language access interventions on clinical outcomes. Variability in how language discordance is defined and measured across studies was also identified as a limitation.
The authors recommend developing a more standardized approach to identifying patients facing language-related barriers to care and determining whose language preferences — whether the patient’s or a parent’s — are most influential in shaping clinical outcomes.
