title: Impact of language barriers on stroke care and outcomes.
abstract: OBJECTIVE
  Language barriers may lead to poor quality of care, particularly for conditions like acute stroke for which diagnosis and treatment decision making rely on taking an accurate patient history. The purpose of this study was to determine the impact of patient language barriers on quality of stroke care and clinical outcomes.
  
  
  METHODS
  This retrospective cohort study used data from the Registry of the Canadian Stroke Network. All Ontario patients who were admitted with acute stroke or transient ischemic attack between July 2003 and March 2008 were selected. Mortality, stroke outcomes, in-hospital complications, quality of care, and disposition were compared between those without (n=12 787) and with (n=1506) language barriers, which was defined based on the patient's preferred language. Hierarchical multivariable regression models determined the effect of language barriers, independent of baseline covariates.
  
  
  RESULTS
  Patients with language barriers had better 7-day mortality than those without (7.0% versus 9.2%; OR, 0.69; 95% CI, 0.57-0.82; P<0.001). However, they were more likely to be discharged with a moderate-to-severe neurological deficit (65.9% versus 51.5%; OR, 1.25; 95% CI, 1.15-1.35). In-hospital complication rates did not differ, and quality of care indicators generally favored patients with language barriers.
  
  
  CONCLUSIONS
  Patients who had language barriers had reduced mortality and better performance on some quality of care measures. These differences existed despite adjustment for many potential confounders, including ethnicity, prognostic factors, and stroke characteristics.
authors: From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.). baiju.shah@ices.on.ca.
authors: Baiju R
authors: BR
authors: Shah
authors: From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.).
authors: Nadia A
authors: NA
authors: Khan
authors: From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.).
authors: Martin J
authors: MJ
authors: O'Donnell
authors: From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.).
authors: Moira K
authors: MK
authors: Kapral
mesh_terms: D000368:Aged; D002170:Canada; D003142:Communication; D003657:Decision Making; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality* / Q000628:therapy*; D007802:Language; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: communication barriers; language; mortality; quality of health care