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Language Barriers and Understanding of Hospital Discharge Instructions

Karliner, Leah S. MD*; Auerbach, Andrew MD; Nápoles, Anna PhD*; Schillinger, Dean MD; Nickleach, Dana MS*; Pérez-Stable, Eliseo J. MD*

doi: 10.1097/MLR.0b013e318249c949
Original Articles

Background: Effective communication at hospital discharge is necessary for an optimal transition and to avoid adverse events. We investigated the association of a language barrier with patient understanding of discharge instructions.

Methods: Spanish-speaking, Chinese-speaking, and English-speaking patients admitted to 2 urban hospitals between 2005 and 2008, comparing patient understanding of follow-up appointment type, and medication category and purpose between limited English-proficient (LEP) and English-proficient patients.

Results: Of the 308 patients, 203 were LEP. Rates of understanding were low overall for follow-up appointment type (56%) and the 3 medication outcomes (category 48%, purpose 55%, both 41%). In unadjusted analysis, LEP patients were less likely than English-proficient patients to know appointment type (50% vs. 66%; P=0.01), medication category (45% vs. 54%; P=0.05), and medication category and purpose combined (38% vs. 47%; P=0.04), but equally likely to know medication purpose alone. These results persisted in the adjusted models for medication outcomes: LEP patients had lower odds of understanding medication category (odds ratio 0.63; 95% confidence interval, 0.42–0.95); and category/purpose (odds ratio 0.59; 95% confidence interval, 0.39–0.89).

Conclusions: Understanding of appointment type and medications after discharge was low, with LEP patients demonstrating worse understanding of medications. System interventions to improve communication at hospital discharge for all patients, and especially those with LEP, are needed.

*Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, Division of General Internal Medicine

Department of Medicine, Division of Hospital Medicine

Department of Medicine, Center for Vulnerable Populations at San Francisco General Hospital, Division of General Internal Medicine, University of California at San Francisco, San Francisco, CA

Supported by Grant no. 20061003 from The California Endowment, by Grant no. P30-AG15272 of the Resource Centers for Minority Aging Research program funded by the National Institute on Aging, National Institutes of Health, and by Agency for Healthcare Research and Quality K08 training award K08HS11416.

The authors declare no conflict of interest.

Reprints: Eliseo J. Pérez-Stable, MD, 3333 California Street, Box 0856, San Francisco, CA 94143-0856. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.