Language Barriers and Other Determinants of Post-Intensive Care Unit Follow-Up: A 5-Year Review

To evaluate factors associated with attendance at a post-intensive care syndrome (PICS) follow-up clinic, with a focus on language barriers and socioeconomic status.

We conducted a retrospective cohort study at Mayo Clinic, Rochester, Minnesota, from January 1, 2019, through June 30, 2024. Adult patients (≥18 years) with an ICU stay of 3 days or more who were referred to the PICS clinic were included. We examined 2 levels of outcomes: attendance rates and clinical outcomes among attendees. Attendance was evaluated in relation to demographic and clinical characteristics, language proficiency, interpreter needs, and socioeconomic status measured by the housing-based socioeconomic status index. Among attendees, patient-reported outcomes were assessed using the EuroQol-5D and the posttraumatic stress disorder (PTSD) checklist for DSM-5.

Of 2001 referred patients, 943 (47.1%) attended the clinic. Attendance did not differ significantly by age, sex, race, or housing-based socioeconomic status index quartile but was lower among patients who had language barriers (31.1% vs 47.7%; P=.011) and those requiring interpreter services (29.4% vs 47.6%; P=.010). Longer ICU (≥11 days) or hospital stays (≥21 days) were associated with lower attendance. Among attendees, non-English-speaking patients and those requiring interpreters had markedly lower EuroQol-5D and PTSD Checklist for DSM-5 completion rates. In multivariable analysis, female sex, prolonged hospitalization, and unemployment were independently associated with worse quality of life and PTSD scores.

Language barriers, interpreter needs, and prolonged ICU or hospital stays were associated with lower PICS clinic attendance. Language barriers also reduced engagement with recovery assessments. Targeted outreach, language support, and translated materials may improve attendance and the effectiveness of post-ICU follow-up care for these patients.