Resource utilization rates among English versus limited English proficient patients (pts) by patient-report of low health literacy (LHL).

Abstract

107 Background: About 30 million people in the US report Limited-English Proficiency (LEP). LEP cancer pts are less likely to understand their medical condition(s) and are at increased risk of LHL, emergency department (ED) visits or hospitalizations. We examined the relationship between LEP, LHL, and ED visits/hospitalization in oncology. Methods: Dana-Farber Cancer Institute’s New Pt Intake Questionnaire (NPIQ) documents clinical and social determinants of health, including LHL. Pts reported LHL if they responded “a little bit”, “somewhat” or “not at all” to 1 of 2 questions: 1) “How confident are you in filling out medical forms?” and 2) “How confident are you in understanding medical statistics?”. Pts reported LEP if they noted a primary language other than English at registration. ED visits/hospitalizations were determined from Partners Healthcare System records. Statistically significant relationships between LEP, LHL and ED visits/hospitalizations and pt demographics (age, sex, race/ethnicity, zip code) and clinical (disease center, treatment intent) characteristics were determined with χ2 tests. Results: From 5/30/15 – 4/30/20, 21570 of 98200 eligible pts responded to NPIQ (response rate 22.0%). LHL differed by age (p-value < 0.001), gender (p-value < 0.001) and race/ethnicity (p-value = 0.007). Among LEP pts reporting LHL, financial distress (p-value = 0.004), emotional distress (PROMIS score; p-value = 0.014), and prior cancer (p-value = 0.006) were more prevalent; however, there was no significant statistical increase in ED visits (p-value = 0.237) or hospitalizations (p-value = 0.965) compared to LEP not reporting LHL. Conclusions: The results indicate that sociodemographic and other pt characteristics contribute to ED and hospital utilization in LEP cancer pts. Future studies will employ prospective data to examine the covariates’ predictive ability for resource utilization with LHL among LEP pts. [Table: see text]