Background: People with communication differences, including aphasia, and those from culturally and linguistically diverse backgrounds are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes remains unknown.
Aims: To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia.
Methods: Cross-sectional, patient-level data from hospitals participating in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were aggregated. For people with aphasia, multivariable regression models were used to compare adherence to processes of care and outcomes (e.g. length of stay, independence on discharge [modified Rankin Scale 0-2], discharge destination) by interpreter status. Outcome models were adjusted for sex, stroke type, hospital site and stroke severity factors (e.g. incontinence, arm or mobility impairment,).
Results: Overall, 3122 people with aphasia were identified (median age 78, 51% male) from 126 participating hospitals: 193 (6.2%) required an interpreter (median age 78, 45% male). Compared to people with aphasia who did not require an interpreter, those requiring an interpreter were less likely to have their mood assessed (OR 0.50, 95% CI 0.32, 0.76), but more likely to have a physiotherapy assessment (OR 2.34, 95% CI 1.06, 5.19). People who required an interpreter had a 2 day longer median length of stay (8 days vs 6 days, p=0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89) compared to those who did not require an interpreter.
Conclusion: Differences exist in acute care provision and outcomes for people with aphasia who require an interpreter. Further research is required to explore their needs, the practice needs of their clinicians, and the systems underpinning their clinical pathways.