Reducing Readmission Disparities in Hospitals Serving High Volumes of Patients With Limited English Proficiency

Background: Despite national attention to address disparities in health care, significant language-based health inequities exist in the United States. Objectives: To evaluate whether readmissions for patients with limited English proficiency (LEP) are associated with the LEP volume of the hospital and to determine whether and to what extent the effect of hospital LEP volume on readmissions for LEP patients is conditional on the hospitals’ nurse work environment. Research Design: Cross-sectional analysis using 3 data sources from 2016: New Jersey Discharge Data Collection System, RN4CAST-US survey, and American Hospital Association Annual Survey. Subjects: A total of 424,745 patients, 9.2% of which were defined as having LEP (n=38,906), in 68 hospitals. Measures: The RN4CAST survey utilized the Practice Environment Scale of the Nursing Work Index to measure nurses’ ratings of their hospitals’ nurse work environment. The outcome variable was 7-day readmissions, representing a potentially avoidable re-visit to the hospital. Hospital LEP volume was measured as the percentage of index admissions of LEP patients. Results: In the fully adjusted stratified model, in hospitals with poor work environments, a 10-percentage point increase in LEP volume was significantly associated with 6% higher odds of a 7-day readmission for LEP patients OR=1.06, 95% CI (1.04–1.08), P <0.001. In hospitals with favorable environments, a 10-percentage point increase in LEP volume was associated with 2% higher odds of a 7-day readmission; however, this difference was not statistically significant OR=1.02, 95% CI (0.99–1.06). Conclusion: Readmission disparities were greatest in hospitals serving higher proportions of patients with LEP; however, the disparities were rendered insignificant in hospitals with the favorable nurse work environments.