329 Limited English Proficiency and Acute Health Care Utilization Among Patients With CKD

Abstract

LIMITED ENGLISH PROFICIENCY AND ACUTE HEALTH CARE UTILIZATION AMONG PATIENTS WITH CKD Delphine Tuot, Laura Plantinga, Vanessa Grubbs, and Neil Powe Center for Vulnerable Populations, San Francisco General Hospital, and University of California, San Francisco, CA, USA. Language barriers are associated with decreased access to health care. Patients with limited English proficiency (LEP) may hesitate to access services due to anticipated communication difficulties. We examined the effect of LEP on acute health care utilization among patients with chronic kidney disease (CKD). We examined the impact of LEP status on rates of hospital admissions and emergency department (ED) visits among a cohort of 2249 adult (>20 years) patients with CKD and at least two primary care visits within the San Francisco Department of Public Health Community Health Network (a network of >30 public health clinics) between 2005 and 2010. LEP was defined by preferentially speaking a non-English language. CKD was defined by average estimated glomerular filtrate rate <60 ml/ min/1.73m on two or more creatinine measurements ≥3 months apart. Incidence rate ratios (IRRs) were calculated with negative binomial regression, adjusting for sociodemographic variables and co-morbid conditions. Nearly a third of the cohort (32%) had LEP; 11% spoke Spanish and 13% spoke Chinese (Cantonese or Mandarin). LEP patients had higher rates of hospital admission than English-speaking patients [IRR=1.2, (95%CI, 1.0-1.4)]. This association was similar among Chinese speakers [1.3 (1.0, 1.8)] but not statistically significant among Spanish speakers [1.0 (0.78, 1.4)], relative to English speakers. LEP patients had lower rates of ED visits than English-speaking patients [0.82, (0.67, 1.0)]. This association was similar among Chinese [0.7 (0.5, 0.99)] and Spanish [0.77 (0.55, 1.1)] speakers. Among patients with CKD within a safety net system, LEP was associated with lower ED visit rates but higher hospital admission rates. LEP patients -particularly those speaking languages uncommon among providers— may anticipate communication barriers, thus delaying ED presentations and increasing likelihood of hospital admission.