Importance Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. Objective To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. Design, Setting, and Participants This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?" Main Outcomes and Measures Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. Results Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. Conclusions and Relevance This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.

中文翻译：

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美国医院安全氛围与语言能力患者及家属报告协会。

重要性 有语言障碍的患者经历医院安全事件的风险更高。本研究假设语言障碍与对与沟通开放性相关的医院安全氛围的较差认知有关。目的 通过一组住院儿童及其家人的语言熟练程度来检查所报告的医院安全氛围的差异。设计、设置和参与者 这项队列研究于 2019 年 4 月 29 日至 2020 年 3 月 1 日进行，纳入了美国 21 家医院的普通科和亚专科病房的儿科患者和住院儿童的父母或看护人。随机选择阿拉伯文、中文、英文、在出院前接触说西班牙语的住院患者和家属，如果他们提供语言能力和健康素养数据，则将其纳入分析。参与者通过调查自我评价语言能力。有限的英语水平被定义为对“你英语说得怎么样？”这个问题的回答不是“非常好”。主要成果和措施 主要成果是 top-box（最高；例如，强烈同意） 5 点李克特量表评级 3 个儿童医院安全气候问卷沟通开放项目：(1) 如果您看到可能产生负面影响的事情，请自由发言护理（顶部回复：强烈同意），（2）质疑医疗保健提供者的决定或行动（顶部回复：强烈同意），(3) 当事情看起来不对时害怕提问（顶框反应：强烈反对 [反向编码项目]）。协变量包括健康素养和社会人口学特征。逻辑回归与广义估计方程一起用于控制站点聚类，以模拟开放性项目和语言能力之间的关联，并根据健康素养和社会人口特征进行调整。结果 在接触参与研究的 813 名患者、父母和看护者中，608 人完成了调查（74.8% 的回应率）。共有 87.7%（608 人中的 533 人）的参与者（434 名 [82.0%] 女性）完成了语言能力和健康素养项目，并被纳入分析；其中，14.1% (75) 的英语水平有限。如果英语水平有限的参与者看到可能对护理产生负面影响的事情（调整后的优势比 [aOR]，0.26；95% CI，0.15-0.43）、质疑医疗保健提供者的决定或行动（aOR），他们自由发言的可能性较低, 0.19；95% CI, 0.09-0.41)，并且在事情看起来不对劲时不怕提问 (aOR, 0.44; 95% CI, 0.27-0.71)。健康素养有限 (aOR, 0.66; 95% CI, 0.48-0.91) 和受教育程度较低 (aOR, 0.59; 95% CI, 0.36-0.95) 的人也不太可能质疑决定或行动。结论和相关性 这项队列研究发现，英语水平有限与直言不讳、质疑提供者的决定或行为以及在事情看起来不对劲时不怕提问的可能性较低有关。对于英语水平有限的患者，这种差异可能会导致更高的医院安全风险。有必要致力于改善与英语水平有限的患者和家属的沟通，以提高医院安全性和减少差异。