The effect of Section 1557 of the Affordable Care Act on surgical outcomes in non-English primary language speakers.

Affordable care Act Outcomes Primary language Section 1557

Journal

American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473

Informations de publication

Date de publication:
Jan 2024
Historique:
received: 21 06 2023
revised: 01 09 2023
accepted: 02 10 2023
pubmed: 19 10 2023
medline: 19 10 2023
entrez: 18 10 2023
Statut: ppublish

Résumé

In 2016, Section 1557 mandated use of qualified language interpreter services. We examined the effect of Section 1557 on surgical outcomes. Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2013-2020), we performed a difference-in-differences analysis of adult surgical patients (Maryland, New Jersey). The exposure was implementation of Section 1557 (pre-period: 2013-2015; post-period: 2017-2020). The treatment group was non-English primary language speakers (n-EPL). The comparison group was English primary language speakers (EPL). Outcomes included length-of-stay, postoperative complications, mortality, discharge disposition, and readmissions. Among 2,298,584 patients, 198,385 (8.6%) were n-EPL. After implementation of Section 1557, n-EPL saw no difference in readmission rates but did experience significantly higher rates of mortality (+0.43%, p ​= ​0.049) and non-routine discharges (+1.81%, p ​= ​0.031) in Maryland, and higher rates of post-operative complications (+0.31%, p ​= ​0.001) in both states, compared to pre-Section 1557. Contrary to our hypothesis, Section 1557 did not improve surgical outcomes for n-EPL.

Sections du résumé

BACKGROUND BACKGROUND
In 2016, Section 1557 mandated use of qualified language interpreter services. We examined the effect of Section 1557 on surgical outcomes.
METHODS METHODS
Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2013-2020), we performed a difference-in-differences analysis of adult surgical patients (Maryland, New Jersey). The exposure was implementation of Section 1557 (pre-period: 2013-2015; post-period: 2017-2020). The treatment group was non-English primary language speakers (n-EPL). The comparison group was English primary language speakers (EPL). Outcomes included length-of-stay, postoperative complications, mortality, discharge disposition, and readmissions.
RESULTS RESULTS
Among 2,298,584 patients, 198,385 (8.6%) were n-EPL. After implementation of Section 1557, n-EPL saw no difference in readmission rates but did experience significantly higher rates of mortality (+0.43%, p ​= ​0.049) and non-routine discharges (+1.81%, p ​= ​0.031) in Maryland, and higher rates of post-operative complications (+0.31%, p ​= ​0.001) in both states, compared to pre-Section 1557.
CONCLUSIONS CONCLUSIONS
Contrary to our hypothesis, Section 1557 did not improve surgical outcomes for n-EPL.

Identifiants

DOI: 10.1016/j.amjsurg.2023.10.018 PMID: 37852843
pubmed: 37852843
pii: S0002-9610(23)00524-X
doi: 10.1016/j.amjsurg.2023.10.018
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

189-197

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare no conflicts of interests.

Auteurs

Emna Bakillah (E)

Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Emna.Bakillah@pennmedicine.upenn.edu.

Caitlin B Finn (CB)

Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

James Sharpe (J)

Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

Rachel R Kelz (RR)

Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

Classifications MeSH