Research Objective: To differentiate the effects on 30 day readmission risk of having a language concordant vs. a non-language concordant registered nurse conduct home health care visits for limited English proficiency patients who spoke Spanish, Russian, Mandarin, Cantonese, or Korean. Study Design: A secondary analysis of electronic patient record data from 2010-2014 collected from an urban home health care agency serving a significant limited English proficiency population. Patient records were matched using propensity scoring methods and inverse probability weighting to control for comorbidities. To examine the effects of language concordant registered nurse visits, human resources records were matched with patient visit data to determine the frequency, length, and other visit factors on patient risk for 30 day readmission. Kruskal-Wallis tests determined between language group differences for continuity of care in home care visits (e.g. the same nurse visiting the patient each time). Population Studied: 143,805 patients formed the dataset with 34,124 matched English speaking and non-English preferred patients resulting in the sample for the analysis. Principal Findings: Patient's language preference affected the continuity of care with Russian, Mandarin, and Cantonese speakers having higher rates of continuity of care than English or Spanish speakers (p<0.001). Spanish speakers were the least likely patients to receive language concordant visits from a registered nurse while Mandarin, Cantonese, Korean, and Russian speakers had similar rates of language concordant visits by registered nurses. Readmission risk was overall 1% lower for English speakers compared to limited English proficiency individuals. Limited English proficiency patients needed at least 50% language concordant home care visits to achieve clinically significant reductions in readmission risk and 85% language concordant visits to have the same readmission risk as English speaking patients. With 85% or greater language concordant visits, readmission risk for limited English proficiency patients reduced between 1.5% to 7% and was specific to language group. Conclusions: Limited English proficiency patient risk for readmission to the hospital from home care can be reduced through language concordant home care visits with registered nurses. Language concordant visits may also help improve continuity of care in home care and subsequently, patient outcomes. Implications for Policy or Practice: With Medicare reimbursement models now factoring in patient language preference, these findings present significant policy challenges for home care organizations and insurance reimbursement for services. Because of shortages of registered nurses who speak languages other than English, it may not be possible for home care agencies to hire enough staff to meet the demands for language concordant services. In-person certified medical interpreters could help reduce readmission risk but currently, their services are not reimbursed in home care. Telephone interpreter use in home care does not appear effective for reducing readmission risk, based on this analysis, but requires further study. Reimbursement for interpreter services in home care could improve patient outcomes.
Squires, A., Miner, S., Ma, C., Feldman, P., & Jones, S. (2018). Language Concordant Home Care Visits Reduce 30 Day Readmissions in Limited English Proficiency Patients. In AcademyHealth Annual Research Meeting (p. Accessed September 10, 2018). Retrieved from https://academyhealth.confex.com/academyhealth/2018arm/meetingapp.cgi/Paper/26081