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Language barriers may help stroke patients get better care: ICES study


Language barriers were often believed to lead to poor quality of care for many reasons, including misdiagnosis, delays in care and decreased patient engagement. In stroke care, physicians often rely on eliciting subjective patient symptoms, and treatment decisions may hinge on definitively establishing the time since the onset of symptoms. However, researchers at the Institute for Clinical Evaluative Sciences (ICES) have found stroke patients with language barriers had an approximately 30 per cent reduced rate of death at seven days and 30 days, and a more than 20 per cent reduced rate of death at one year.

“We were quite surprised by the results. We anticipated that patients with language barriers would do poorly when admitted for stroke, because it is a disease where being able to communicate is really important – getting details on specific subjective symptoms and their timing, for example, can greatly impact how patients are treated,” said Dr. Baiju Shah, lead author and scientist at ICES.

The study, published today in Stroke, examined how language barriers impacted the quality of care and clinical outcomes for acute stroke.

The cohort study identified 14,293 patients admitted for stroke at 12 stroke centres in Ontario from July 2003 to March 2008, of whom 1,506 (10.5 per cent) had a language barrier. Language barrier was defined as a patient who reported a preferred language other than English or French.

The 7-day mortality rate was 7.0 per cent among those with language barriers and 9.2 per cent among those without. Similar results were seen for 30 day and 1 year mortality. In contrast, patients with language barriers were more likely to be discharged from hospital with a moderate-to-severe residual neurological deficit (65.9 per cent versus 51.5 per cent). In-hospital complications were rare, and not statistically significantly different between those with and without language barriers. However, those with language barriers had longer median lengths of stay.

“We don’t yet have a complete explanation for this. Some hypotheses include that clinicians may order more tests, or get more paramedical personnel involved if they can’t communicate with the patient. Another may be that the patients we studied with language barriers were less likely to be placed in palliative care, and seemed to prefer more aggressive treatment – so that may have contributed to less mortality,” said Shah.

“The impact of language barriers on stroke care and outcomes,” was published today in Stroke.

Author block: Baiju R Shah, Nadia A Khan, Martin J O’Donnell and Moira K Kapral.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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