title: Language barriers and understanding of hospital discharge instructions.
abstract: BACKGROUND
  Effective communication at hospital discharge is necessary for an optimal transition and to avoid adverse events. We investigated the association of a language barrier with patient understanding of discharge instructions.
  
  
  METHODS
  Spanish-speaking, Chinese-speaking, and English-speaking patients admitted to 2 urban hospitals between 2005 and 2008, comparing patient understanding of follow-up appointment type, and medication category and purpose between limited English-proficient (LEP) and English-proficient patients.
  
  
  RESULTS
  Of the 308 patients, 203 were LEP. Rates of understanding were low overall for follow-up appointment type (56%) and the 3 medication outcomes (category 48%, purpose 55%, both 41%). In unadjusted analysis, LEP patients were less likely than English-proficient patients to know appointment type (50% vs. 66%; P=0.01), medication category (45% vs. 54%; P=0.05), and medication category and purpose combined (38% vs. 47%; P=0.04), but equally likely to know medication purpose alone. These results persisted in the adjusted models for medication outcomes: LEP patients had lower odds of understanding medication category (odds ratio 0.63; 95% confidence interval, 0.42-0.95); and category/purpose (odds ratio 0.59; 95% confidence interval, 0.39-0.89).
  
  
  CONCLUSIONS
  Understanding of appointment type and medications after discharge was low, with LEP patients demonstrating worse understanding of medications. System interventions to improve communication at hospital discharge for all patients, and especially those with LEP, are needed.
authors.affiliation: Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, Division of General Internal Medicine, USA.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Karliner
authors.forename: Andrew
authors.initials: A
authors.lastname: Auerbach
authors.forename: Anna
authors.initials: A
authors.lastname: Nápoles
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Dana
authors.initials: D
authors.lastname: Nickleach
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
mesh_terms: D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D003144:Communication Barriers; D032882:Comprehension; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge; D055815:Young Adult