The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada

• DOI: 10.1186/s12913-020-05213-6
• Publication Date: 2020-04-21T13:02:41Z
• Authors: Michael Reaume; Ricardo Batista; Robert Talarico; Emily Rhodes; Eva Guerin; Sarah Carson; Denis Prud’homme; Peter Tanuseputro
• Keywords: Male; Language barriers; Multilingualism; 03 medical and health sciences; 0302 clinical medicine; Harm Reduction; Risk Factors; Harmful events; Humans; Language discordance; Minority Groups; Aged; Retrospective Studies; 360; Aged, 80 and over; Ontario; Inpatients; Communication Barriers; Disease Management; Middle Aged; Home Care Services; Language concordance; 3. Good health; Hospitalization; Patient safety; Chronic Disease; Female; Patient Safety; Public aspects of medicine; RA1-1270; Linguistic minorities; Research Article

Abstract Background Patients who live in minority language situations are generally more likely to experience poor health outcomes, including harmful events. The delivery of healthcare services in a language-concordant environment has been shown to mitigate the risk of poor health outcomes related to chronic disease management in primary care. However, data assessing the impact of language-concordance on the risk of in-hospital harm are lacking. We conducted a population-based study to determine whether admission to a language-discordant hospital is a risk factor for in-hospital harm.

Methods We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2007 to 2015) who were admitted to a hospital in Eastern or North-Eastern Ontario, Canada. Patient language (obtained from home care assessments) was coded as English (Anglophone group), French (Francophone group), or other (Allophone group); hospital language (English or bilingual) was obtained using language designation status according to the French Language Services Act. We identified in-hospital harmful events using the Hospital Harm Indicator developed by the Canadian Institute for Health Information.

Results The proportion of hospitalizations with at least 1 harmful event was greater for Allophones (7.63%) than for Anglophones (6.29%, p < 0.001) and Francophones (6.15%, p < 0.001). Overall, Allophones admitted to hospitals required by law to provide services in both French and English (bilingual hospitals) had the highest rate of harm (9.16%), while Francophones admitted to these same hospitals had the lowest rate of harm (5.93%). In the unadjusted analysis, Francophones were less likely to experience harm in bilingual hospitals than in hospitals that were not required by law to provide services in French (English-speaking hospitals) (RR = 0.88, p = 0.048); the opposite was true for Anglophones and Allophones, who were more likely to experience harm in bilingual hospitals (RR = 1.17, p < 0.001 and RR = 1.41, p < 0.001, respectively). The risk of harm was not significant in the adjusted analysis.

Conclusions Home care recipients residing in Eastern and North-Eastern Ontario were more likely to experience harm in language-discordant hospitals, but the risk of harm did not persist after adjusting for confounding variables.