title: Emergency department and inpatient health care utilization among patients who require interpreter services.
abstract: BACKGROUND
  Limited English proficiency is associated with health disparities and suboptimal health outcomes. Although Limited English proficiency is a barrier to effective health care, its association with inpatient health care utilization is unclear. The aim of this study was to examine the association between patients with limited English proficiency, and emergency department visits and hospital admissions.
  
  
  METHODS
  We compared emergency department visits and hospitalizations in 2012 between patients requiring interpreter services and age-matched English-proficient patients (who did not require interpreters), in a retrospective cohort study of adult patients actively empanelled to a large primary health care network in a medium-sized United States city (n = 3,784).
  
  
  RESULTS
  Patients who required interpreter services had significantly more Emergency Department visits (841 vs 620; P ≤ .001) and hospitalizations (408 vs 343; P ≤ .001) than patients who did not require interpreter services. On regression analysis the risk of a first Emergency Department visit was 60% higher for patients requiring interpreter services than those who did not (unadjusted hazard ratio [HR], 1.6; 95% confidence interval (CI), 1.4-1.9; P < .05), while that of a first hospitalization was 50% higher (unadjusted HR, 1.5; 95% CI, 1.2-1.8; P < .05). These findings remained significant after adjusting for age, sex, medical complexity, residency and outpatient health care utilization.
  
  
  CONCLUSIONS
  Patients who required interpreter services had higher rates of inpatient health care utilization compared with patients who did not require an interpreter. Further research is required to understand factors associated with this utilization and to develop sociolinguistically tailored interventions to facilitate appropriate health care provision for this population.
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. Njeru.jane@mayo.edu.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Njeru
authors.affiliation: Division of Epidemiology, Mayo Clinic, Rochester, MN, USA. stsauver.jennifer@mayo.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. djacobsn@mayo.edu.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA. Ebbert.jon@mayo.edu.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. akahashi.paul@mayo.edu.
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. fan.chun@mayo.edu.
authors.forename: Chun
authors.initials: C
authors.lastname: Fan
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. Wieland.mark@mayo.edu.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wieland
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003144:Communication Barriers; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007802:Language; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States