title: The Association Between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours.
abstract: Language barriers are known to negatively affect many health outcomes among limited English proficiency patient populations, but little is known about the quality of care such patients receive in the emergency department (ED). This study seeks to determine whether limited English proficiency patients experience different quality of care than English-speaking patients in the ED, using unplanned revisit within 72 hours as a surrogate quality indicator.
  
  
  
  We conducted a retrospective cohort study in an urban adult ED in 2012, with a total of 41,772 patients and 56,821 ED visits. We compared 2,943 limited English proficiency patients with 38,829 English-speaking patients presenting to the ED after excluding patients with psychiatric complaints, altered mental status, and nonverbal states, and those with more than 4 ED visits in 12 months. Two main outcomes-the risk of inpatient admission from the ED and risk of unplanned ED revisit within 72 hours-were measured with odds ratios from generalized estimating equation multivariate models.
  
  
  
  Limited English proficiency patients were more likely than English speakers to be admitted (32.0% versus 27.2%; odds ratio [OR]=1.20; 95% confidence interval [CI] 1.11 to 1.30). This association became nonsignificant after adjustments (OR=1.04; 95% CI 0.95 to 1.15). Included in the analysis of ED revisit within 72 hours were 32,857 patients with 45,546 ED visits; 4.2% of all patients (n=1,380) had at least 1 unplanned revisit. Limited English proficiency patients were more likely than English speakers to have an unplanned revisit (5.0% versus 4.1%; OR=1.19; 95% CI 1.02 to 1.45). This association persisted (OR=1.24; 95% CI 1.02 to 1.53) after adjustment for potential confounders, including insurance status.
  
  
  
  We found no difference in hospital admission rates between limited English proficiency patients and English-speaking patients. Yet limited English proficiency patients were 24% more likely to have an unplanned ED revisit within 72 hours, with an absolute difference of 0.9%, suggesting challenges in ED quality of care.
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, New York University School of Medicine, New York, NY. Electronic address: kaming.ngai@mountsinai.org.
authors.forename: Ka Ming
authors.initials: KM
authors.lastname: Ngai
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Corita R
authors.initials: CR
authors.lastname: Grudzen
authors.affiliation: Department of Biology, St. Francis College, Brooklyn, NY.
authors.forename: Roy
authors.initials: R
authors.lastname: Lee
authors.affiliation: Institute of Human Nutrition, Columbia University Medical Center, New York, NY.
authors.forename: Vicky Y
authors.initials: VY
authors.lastname: Tong
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Richardson
authors.affiliation: Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D003144:Communication Barriers; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors