Patient-provider Language Concordance Research Articles

Family Language Preference, Not Provider-Family Language Concordance, Predicts Integrated Psychology Treatment Engagement in a Spanish-English Bilingual Clinic.

Monolingual Spanish speakers-many of whom identify as Hispanic/Latine-often experience barriers to accessing psychology services, including language access. Integrated primary care (IPC) clinics, where individuals receive psychological services within primary care, aim to improve service accessibility. However, minoritized populations are less likely to engage with these services than non-Hispanic/Latine White individuals. Few studies examine psychology treatment engagement within pediatric integrated clinics for Spanish-speaking families. This study investigated differences in psychology treatment engagement for Spanish-speaking families and the role of patient-provider language concordance within pediatric IPC. A retrospective chart review examined data from a multiethnic sample of 887 patients (M age = 8.97 yrs, 55.69% male, 64.83% Hispanic/Latine, 6.99% non-Hispanic/Latine White, 41.71% Spanish-preferring) from an urban pediatric IPC clinic serving a high proportion of Hispanic/Latine, Spanish-speaking families. We examined the association between language preference and patient-provider language concordance on service engagement using hierarchical linear regression. Spanish-preferring families were more likely than English-preferring families to engage in psychology services. Working with a Spanish-speaking provider during an initial psychology visit was unrelated to psychology treatment engagement for Spanish-preferring families. Higher engagement for Spanish-preferring families seems to reflect the clinic's reputation as a center for linguistically accessible services. While linguistic accessibility remains important, our study did not detect an effect of language concordance during the initial psychology visit and subsequent treatment engagement. The findings highlight the importance of providing culturally responsive and linguistically accessible mental health services for Spanish-speaking families.

The Association of Patient-Provider Language Concordance with Healthcare Comprehension Among Mexican-origin Latino/as in Oregon

Objective: To understand the local Mexican-origin Latino community’s preference for bilingual health care providers and understand the relationship between language concordant care and comprehension of a healthcare visit. Background: Language barriers in healthcare negatively impact quality of care. Language concordant care (where a health care provider speaks the patient’s language) has been shown to result in better patient comprehension than using interpreters/translators. Study Design: This is a cross sectional study in collaboration with the General Consulate of Mexico. We developed a 20-item survey that includes questions about socio-demographics, an acculturation scale, and questions regarding language concordant care experience and preferences. Participants were aged 18 or older who had a healthcare visit within the past 12 months. We used descriptive and multivariable statistics to describe our sample and test the association of language concordant care and comprehension of the healthcare visit. Results We recruited 505 participants who all completed the survey in Spanish. Overall, 93.5% reported preference for a language concordant provider and 32.9% reported receipt of such care. Of those who reported a concordant provider visit, 87% reported a regular source of care compared to 50% among those with a discordant provider (p<0.001). In multivariable analyses, patients with a concordant provider had higher odds of understanding everything their provider said (aOR = 10.53 (95% CI: 6.60-16.81). Conclusion There is a gap between the preference for language concordant providers and the receipt of this type of health care for Oregon Latinos. Increasing access to language concordant care can contribute to improving health care quality, equity, and outcomes for Latinos in Oregon.

Cross-Sectional Association of Patient Language and Patient-Provider Language Concordance with Video Telemedicine Use Among Patients with Limited English Proficiency.

Telemedicine's dramatic increase during the COVID-19 pandemic elevates the importance of addressing patient-care gaps in telemedicine, especially for patients with limited English proficiency. To examine the associations of patient language and patient-provider language concordance with telemedicine visit type (video versus telephone visit). Cross-sectional automated data study of patient-scheduled primary care telemedicine appointments from March 16, 2020, to October 31, 2020. Northern California integrated healthcare delivery system. All 22,427 completed primary care telemedicine visits scheduled by 13,764 patients with limited English proficiency via the patient portal. Cross-sectional association of electronic health record-documented patient language (Spanish as referent) and patient-provider language concordance with patients' choice of a video (versus telephone) visit, accounting for patient sociodemographics, technology access, and technology familiarity factors. Of all patient-scheduled visits, 34.5% (n = 7747) were video visits. The top three patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). Adjusting for sociodemographic and technology access and familiarity factors and compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese (OR = 1.34, 95% CI: 1.18-1.52), Mandarin (OR = 1.33, 95% CI: 1.16-1.52), or Vietnamese (OR = 1.27, 95% CI: 1.09-1.47), but lower among patients speaking Punjabi (OR = 0.75, 95% CI: 0.75, 0.62-0.91). Language concordance was associated with lower video visit use (OR = 0.86, 95% CI: 0.80-0.93) and moderated associations of speaking Spanish, Cantonese, and Korean with video visit use. In addition, for all language groups, those with prior video visit use were more likely to re-use video visits compared to those with no prior use (p < .05 for all languages except Hindi with p = 0.06). Among linguistically diverse patients with limited English proficiency, video telemedicine use differed by specific language. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.

Limited English Proficiency and Screening for Cervical, Breast, and Colorectal Cancers among Asian American Adults.

Literature shows that limited English proficiency (LEP) influences individual healthcare-seeking behaviors. The Asian population is the fastest-growing racial/ethnic group in the US, and approximately 50% of foreign-born Asians are estimated to live with LEP. To examine associations of LEP and patient-provider language concordance (PPLC) with evidence-based cancer screening utilization for cervical, breast, and colorectal cancers among Asian American adults. We obtained LEP, PPLC, and up-to-date status on the three types of cancer screening from a nationally representative sample of Asian Americans aged ≥ 18years in the 2010-2016 and 2018 Medical Expenditure Panel Surveys. We used multivariable logistic regression models with recommended survey weighting to examine associations of LEP and PPLC with the cancer screening uptake based on USPSTF guidelines. The study population comprised 8953 respondents, representing 8.17 million Asian American adults. Overall, 11.9% of respondents experienced LEP; of those with LEP, 20% were with PPLC. In multivariable models, compared to respondents without LEP, respondents with LEP and without PPLC were significantly less likely to report up-to-date status on breast (OR = 0.44; 95% CI: 0.26-0.76), cervical (OR = 0.44; 95% CI: 0.26-0.75), or colorectal cancer screening (OR = 0.46; 95% CI: 0.26-0.80). However, these differences were not detected in respondents with LEP and with PPLC. LEP is associated with lower up-to-date status on cancer screening among Asian Americans, while PPLC seems to moderate this association. These findings suggest the enhancement for language-appropriate and culturally competent healthcare for Asian Americans with LEP, which helps accommodate their communication needs and promotes cancer screening.

The Influence of Patient–Provider Language Concordance in Cancer Care: Results of the Hispanic Outcomes by Language Approach (HOLA) Randomized Trial

Delivering linguistically competent care is critical to serving patients who have limited English proficiency (LEP) and represents a key national strategy to help reduce health disparities. Current acceptable standards of communication with patients who have LEP include providers communicating through professional interpretive services or bilingual providers speaking the patients' preferred language directly. This randomized clinical trial tests the effect of patient-provider language concordance on patient satisfaction. Eighty-three adult Spanish-speaking patients with cancer were randomly assigned to receive care from either (1) 1 of 2 bilingual physicians speaking to the patient directly in Spanish or (2) the same physicians speaking English and using a professional interpreter service. Validated questionnaires were administered to assess patient-reported satisfaction with both provider communication and overall care. Transcripts of initial consultations were analyzed for content variations. Compared with patients receiving care through professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care (mean composite score [MCS], 4.41 vs 4.06; P=.005), care team interpersonal manner (MCS, 4.37 vs 3.88; P=.004), communication (MCS, 4.50 vs 4.25; P=.018), and time spent with patient,(MCS, 4.30 vs 3.92; P=.028). Specific to physician communication, patients rated direct-Spanish care more highly in perceived opportunity to disclose concerns (MCS 4.91 vs 4.62; P=.001), physician empathy (MCS, 4.94 vs 4.59; P <.001), confidence in physician abilities (MCS, 4.84 vs 4.51; P=.001), and general satisfaction with their physician (MCS, 4.88 vs 4.59; P <.001). Analyzing the content of consultation encounters revealed differences between study arms, with the direct-Spanish arm having more physician speech related to patient history verification (mean number of utterances, 13 vs 9; P=.01) and partnering activities (mean utterances, 16 vs 5; P <.001). Additionally, patients in the direct-Spanish arm were more likely to initiate unprompted speech (mean utterances, 11 vs 3; P <.001) and asked their providers more questions (mean utterances, 11 vs 4; P=.007). This study shows improved patient-reported satisfaction among patients with cancer who had LEP and were cared for in direct Spanish compared with interpreter-based communication. Further research into interventions to mitigate the patient-provider language barrier is necessary to optimize care for this population.

The Influence of Patient-Provider Language Concordance in Cancer Care: Results of the Hispanic Outcomes by Language Approach (HOLA) Randomized Trial

Delivering linguistically competent care is critical to serving limited English proficiency (LEP) patients, and represents a key national strategy to help reduce health disparities. Current acceptable standards of communication with LEP patients include providers communicating through professional interpretive services, or bilingual providers speaking the patients’ preferred language directly. This study tests the impact of patient-provider language concordance on patient satisfaction with a randomized clinical trial. Eighty-three adult Spanish-speaking cancer patients were randomized to receive care from either 1) a bilingual physician speaking to the patient directly in Spanish or 2) from the same physicians speaking English and using a professional interpreter service. Validated questionnaires were administered to assess patient-reported satisfaction with both provider communication and overall care. Audio recordings of initial consultations with oncologists were transcribed and analyzed for content variations. Compared to patients receiving care through professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care, care team interpersonal manner, communication, and time spent with patient. Specific to physician communication, patients rated direct Spanish care more highly in perceived opportunity to disclose concerns, physician empathy, confidence in physician abilities, and general satisfaction with their physician. Analyzing the content of consultation encounters revealed differences between study arms, with the direct Spanish arm having more physician speech related to patient history verification and partnering activities. Additionally, patients in the direct-Spanish arm were more likely to initiate unprompted speech, and asked their providers more questions. This study demonstrates improved patient-reported satisfaction among LEP cancer patients cared for in direct Spanish compared to patients cared for with interpreter-based communication. Further research into interventions to mitigate this patient-provider language barrier is necessary to optimize care for this minority population.

Abstract A035: The influence of patient-provider language concordance in cancer care: Results of the Hispanic Outcomes by Language Approach (HOLA) randomized trial

Abstract Purpose: Delivering linguistically competent care is critical to serving limited English proficiency patients, and represents a key national strategy to reduce health disparities. Current acceptable standards of communication with non-English speaking patients include providers communicating through professional interpretive services, or bilingual providers speaking patients’ non-English languages directly. This study tests the impact of patient-provider language concordance on patient satisfaction through the conduct of a randomized clinical trial. Methods and Materials: Eighty-three adult Spanish-speaking cancer patients were randomized to receive care from either 1) a bilingual physician speaking to a patient directly in Spanish or 2) from the same physician speaking English and using a professional interpreter service. Validated questionnaires were administered to assess patient-reported satisfaction with both provider communication and overall care. Audio recordings of initial consultations with oncologists were transcribed and analyzed for content variations. Results: Compared to using professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care, care team interpersonal manner, communication, and time spent with patient. Specific to physician communication, patients rated direct Spanish care more highly in perceived opportunity to disclose concerns, physician empathy, confidence in physician abilities, and general satisfaction with their physician. Analyzing the content of consultation encounters revealed differences between study arms, with the direct Spanish arm having more physician speech related to patient history verification and partnering activities. Additionally, patients in the direct-Spanish arm were more likely to initiate unprompted speech, and ask their providers questions. Conclusions: This study demonstrates improved patient-reported satisfaction among Spanish-speaking cancer patients cared for in direct Spanish compared to patients cared for with interpreter-based communication. Further research into interventions to mitigate this patient-provider language barrier is necessary to optimize care for this minority population. Citation Format: Daniel M Seible, Souma Kundu, Alexa Azuara, Daniel Cherry, Steven Arias, Vinit Nalawade, Jonathan Cruz, Rolando Arreola, Elena M Martinez, Jesse Nodora, Douglas A Rahn, James D Murphy. The influence of patient-provider language concordance in cancer care: Results of the Hispanic Outcomes by Language Approach (HOLA) randomized trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A035.

Patient Knowledge, Beliefs and Barriers to Hepatitis B Care: Results of a Multicenter, Multiethnic Patient Survey.

A greater understanding of the determinants of health behavior among those with and at-risk of chronic hepatitis B virus (HBV) infection is needed for effective design and implementation of public health initiatives. To determine factors associated with (1) willingness to accept HBV antiviral treatment and (2) satisfaction with provider communication regarding HBV care in a diverse cohort of HBV-infected patients. Using a multifaceted model of health behavior, the Health Behavior Framework, we conducted a comprehensive assessment of knowledge, attitudes, beliefs, and barriers to HBV care. We enrolled 510 patients, with mean age 46years; 53.1% men; and 71.6% Asian or Hawaiian/Pacific Islander. Patients were knowledgeable about HBV infection, but one-fifth did not think that HBV was a treatable disease; over a quarter felt it was so common among family and friends that it did not concern them, and less than half of patients believed they were likely to have liver problems or transmit HBV to others during their lifetime. Perceived susceptibility to disease risk was the only independent predictor of willingness to accept HBV treatment (β = 0.23, p = 0.0005), and contrary to expectations, having a doctor that speaks the same language was predictive of lower patient satisfaction with provider communication about their HBV care (β = - 0.65, p < 0.0001). Patients with greater perceived susceptibility to the health consequences of HBV infection are more likely to accept treatment, and patient-provider language concordance impacts patient satisfaction with communication regarding HBV care in an unexpected direction.

Healthcare facility-based strategies to improve tuberculosis testing and linkage to care in non-U.S.-born population in the United States: A systematic review.

ContextAn estimated 21% of non-U.S.-born persons in the United States have a reactive tuberculin skin test (TST) and are at risk of progressing to TB disease. The effectiveness of strategies by healthcare facilities to improve targeted TB infection testing and linkage to care among this population is unclear.Evidence acquisitionFollowing Cochrane guidelines, we searched several sources to identify studies that assessed strategies directed at healthcare providers and/or non-U.S.–born patients in U.S. healthcare facilities.Evidence synthesisSeven studies were eligible. In a randomized controlled trial (RCT), patients with reactive TST who received reminders for follow-up appointments were more likely to attend appointments (risk ratio, RR = 1.05, 95% confidence interval 1.00–1.10), but rates of return in a quasi-RCT study using patient reminders did not significantly differ between study arms (P = 0.520). Patient-provider language concordance in a retrospective cohort study did not increase provider referrals for testing (P = 0.121) or patient testing uptake (P = 0.159). Of three studies evaluating pre and post multifaceted interventions, two increased TB infection testing (from 0% to 77%, p < .001 and RR 2.28, 1.08–4.80) and one increased provider referrals for TST (RR 24.6, 3.5–174). In another pre-post study, electronic reminders to providers increased reading of TSTs (RR 2.84, 1.53–5.25), but only to 25%. All seven studies were at high risk of bias.ConclusionsMultifaceted strategies targeting providers may improve targeted TB infection testing in non-U.S.-born populations visiting U.S. healthcare facilities; uncertainties exist due to low-quality evidence. Additional high-quality studies on this topic are needed.

Patient-Provider Language Concordance and Health Outcomes: A Systematic Review, Evidence Map, and Research Agenda.

Although patient-provider language concordance has the potential to reduce health disparities for people with limited English proficiency, no previous work has synthesized this literature. Our systematic review sought to describe the characteristics of studies examining relationships between language concordance and health outcomes, summarize the nature of observed associations, and propose an evidence map and research agenda. A comprehensive search of published articles identified 38 quantitative studies for inclusion. Most studies were cross-sectional, conducted in primary care, concentrated in Western states, and focused on Spanish speakers and physician providers. Results were split between supporting a positive association versus no association of language concordance with patient behaviors, provider behaviors, interpersonal processes of care, and clinical outcomes. Several methodological limitations were identified. Based on these results, we developed an evidence map, identified knowledge gaps, and proposed a research agenda. There is a particular need for quasi-experimental longitudinal studies with well-characterized samples.

Transitional Care among Minority Patients: the role of Health Literacy, Caregiver Presence and Language-concordant Care

Introduction: Patients with low health literacy (HL) and minority patients encounter many challenges during transition from hospital to community care. We aimed to assess care transitions of patients from minority Arab and immigrant population groups and various HL levels and to test whether presence of caregivers and provision of language-concordant care are associated with better transitions. Methods: This prospective cohort study included 598 internal medicine patients, Hebrew, Russian, or Arabic native speakers, at a tertiary medical center in central Israel, from 2013 to 2014. Baseline measures included: HL (Brief Health Literacy Screen); mental and physical health status (SF-12v.2); daily functioning. A follow-up telephone survey assessed patients’ care transitions (Care Transition Measure [CTM]). Additionally, patients reported on care provisions at discharge: caregiver presence (family members/ close relations) and patient-provider language concordance. Results: Caregivers were present in 59% (351/598) of discharge briefings and patient-provider language concordance was available in 30% (123/408) of minority patients' discharge briefings. Patients with low HL and without language-concordance or caregiver presence had the lowest CTM scores (33.1). When language-concordance and caregivers were available, CTM scores did not differ between the medium-high and low HL groups (72.30 and 68.40, respectively, p=0.118). The adjusted analysis with tests of interaction, showed that language-concordance and caregiver presence during discharge moderate the relationship between HL and patients' care transition experience (p Discussions: This study examined the relationship between HL and patients’ transitional-care experience. Collectively, our data underscore two important points: (1) HL is inversely associated with patients’ ratings of their care transitions, and (2) provisions of care during discharge moderate the relationship between HL and patients' care transition experience. These findings show that the negative impact of low HL is potentially mitigated when language-concordance and caregiver presence are available during discharge. Moreover, our findings on the independent effect of caregiver presence and language-concordance, at both low and medium-high HL levels, show that transitional care of all patients is better when these provisions are available. Nonetheless, for patients with low HL, absence of caregivers and lack of language-concordance is detrimental for their transitional care. Conclusions: This study shows that language-concordance care and caregiver presence are associated with better patients’ transitional-care experience among patients with low HL levels and among minorities in general Lessons learned: Our findings point to a need to identify patients at risk for poor understanding and execution of hospital discharge instructions. This entails determining patients’ HL levels and ensuring that discharge briefings are given by language-concordant providers and when caregivers are present. Limitations: The findings reflect cultural and healthcare characteristics of the Israeli society, which might not be applicable to other countries. However, studies from various developed countries show that deficits in communication at hospital discharge are a common problem that may adversely affect patient care. Suggestions for future research: Future studies should explore how these provisions may lead to improved health outcomes and reductions in hospital readmissions.

Multicultural Transitions: Caregiver Presence and Language-Concordance at Discharge.

Introduction:Patients with low health literacy (HL) and minority patients encounter many challenges during hospital to community transitions. We assessed care transitions of minority patients with various HL levels and tested whether presence of caregivers and provision of language-concordant care are associated with better care transitions.Methods:A prospective cohort study of 598 internal medicine patients, Hebrew, Russian, or Arabic native speakers, at a tertiary medical center in central Israel, from 2013 to 2014.HL was assessed at baseline with the Brief Health Literacy Screen. A follow-up telephone survey was used to administer the Care Transition Measure [CTM] and to assess, caregiver presence and patient–provider language-concordance at discharge.Results:Patients with low HL and without language-concordance or caregiver presence had the lowest CTM scores (33.1, range 0–100). When language-concordance and caregivers were available, CTM scores did not differ between the medium-high and low HL groups (68.7 and 66.9, respectively, p = 0.118). The adjusted analysis, showed that language-concordance and caregiver presence during discharge moderate the relationship between HL and patients’ care transition experience (p < 0.001).Conclusions:Language-concordance care and caregiver presence are associated with higher patients’ ratings of the transitional-care experience among patients with low HL levels and among minorities.

Patient-provider language concordance and choice of treatment for prostate cancer.

6604Background: While some research has suggested that language concordance between patient and provider can impact patient outcomes, it is not known whether language concordance could influence pa...

The Hispanic Clinic for Pediatric Surgery: A model to improve parent–provider communication for Hispanic pediatric surgery patients

Introduction26 million Americans have limited English proficiency (LEP). It is well established that language barriers adversely affect health and health care. Despite growing awareness of language barriers, there is essentially a void in the medical literature regarding the influence of language disparity on pediatric surgery patients. This study was designed to assess the impact of patient–provider language concordance on question-asking behavior and patient satisfaction for pediatric surgery patients. MethodsParticipants included families of patients in a General Pediatric Surgery Clinic categorized into 3 groups by patient–provider language concordance: concordant English-speaking, LEP concordant Spanish-speaking, and LEP discordant Spanish-speaking using an interpreter. Clinical visits were audio recorded and the number of patient-initiated questions and the length of clinical encounter were measured. Families were administered a surgery-specific, 5-point Likert scale questionnaire modeled after validated surveys concerning communication, trust, perceived discrimination and patient–provider language concordance. Regression models were performed to analyze associations between language concordance and patient’s question-asking behavior and between language concordance and survey results. ResultsA total of 156 participants were enrolled including 57 concordant-English, 52 LEP concordant-Spanish and 47 LEP-discordant-Spanish. There was significant variation in the mean number of patient-initiated questions among the groups (p=0.002). Both the English and Spanish concordant groups asked a similar number of questions (p=0.9), and they both asked more questions compared to the Spanish-discordant participants (p=0.002 and p=0.001). Language discordance was associated with fewer questions asked after adjustment for socioeconomic status. Language concordant participants rated higher scores of communication. Both Spanish-concordant and Spanish-discordant patients reported significantly increased preference for, and value of language concordant care. Language discordant participants reported that they desired to ask more questions but were limited by a language barrier (p=0.001). ConclusionsIn a pediatric surgery clinic, language concordant care increases the number of patient-asked questions during a clinical visit and improves communication suggesting that discordant care is a potential source of disparities in access to information. Future efforts should focus on expanding access to language concordant providers in other surgery subspecialties as a step towards limiting disparities in surgical care for all patients.

The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients

BackgroundHispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English. This language barrier adversely affects both access to and quality of care. Surgical specialties trail other medical fields in assessing the effects of language barriers to surgical clinical care and patient satisfaction. This study was designed to assess the effects of patient–provider language concordance on a pediatric surgery practice. MethodsA surgery-specific, 7-point Likert scale questionnaire was designed with 14 questions modeled after validated patient satisfaction surveys from the literature. Questions concerning provider–patient language concordance, quality of understanding, and general satisfaction were included. Surveys were administered to families of patients in the General Pediatric Surgery Clinic at our institution. Families were categorized into three groups: English-speaking, regardless of race/ethnicity; Spanish-speaking using interpreter services with an English-speaking medical team; and Spanish-speaking communicating directly with a Spanish-speaking medical team (Hispanic Center for Pediatric Surgery, HCPS). One-way analysis of variance was used to test for group differences. ResultsWe administered 226 surveys; 49 were removed due to lack literacy proficiency. Families in the HCPS group reported a higher level of satisfaction than the interpreter and English groups (p<0.01). The HCPS group also indicated improved understanding of the information from the visit (p<0.001). Spanish-speaking only families felt that communicating directly with their health care team in their primary language was more important than their English-speaking counterparts (p<0.001). ConclusionsIn a pediatric surgery clinic, language concordant care improves patient satisfaction and understanding for Hispanic families in comparison to language discordant care. Other clinics in other surgery sub-specialties may consider using this model to eliminate language barriers and improve patient satisfaction and understanding of surgical care.

Addressing language barriers and improving quality of transitions and discharge

The article by Rayan et al., “Transitions from Hospital to Community Care: the Role of Patient-Provider Language Concordance”, highlights the importance of language-concordant communication and care during the hospital discharge process. These findings are completely in line with previous research on the impact of language barriers on quality of care. We strongly agree with Rayan et al. and the findings of this important research, and support efforts that help meet the cultural and linguistic needs of patients. Undoubtedly, patient–provider language concordance during the hospitalization discharge process and post discharge follow-up have important implications for health care transitions, quality, and costs. How can hospitals improve their performance in this area? Based on extensive research, there are currently two major hospital guides that were developed in the United States that focus on this area—improving communication and care for patients of diverse backgrounds and with language barriers. One, Project RED—or Re-Engineered Discharge, and the second, Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals, both aim to address these challenges. If we are to truly delivery high-quality, safe, cost-effective care, meeting the needs of patients who experience language barriers during health care will be essential as global migration and diversity increases every day.

Language concordance, interpersonal care, and diabetes self-care in rural Latino patients.

Interpersonal care (IPC) is increasingly emphasized as health care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos. To examine the associations between provider Spanish fluency and Spanish-speaking patients' ratings of IPC and between patient-provider language concordance and patient engagement in diabetes self-care activities. Cross-sectional survey combined with chart reviews. Two hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties. Using a validated questionnaire, we assessed patient ratings of IPC in three areas: communication, decision-making, and interpersonal style. Patient-provider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient self-report. The survey response rate was 68%. Patients with language-concordant providers had more favorable IPC ratings (20% to 41% of language-discordant patients had optimal scores for IPC scales vs. 35% to 69% of language-concordant patients, p < 0.05), except with respect to discrimination. Patients with language-concordant providers reported higher levels of participation in diabetic foot care (1.4 days vs. 0.7 days per week, p value 0.01) compared to patients with language discordance. There was no association between language concordance and participation in other self-care activities. This study provides evidence that language concordance is independently associated with high IPC scores in rural Latino adults with diabetes. Moreover, this study suggests that language concordance may contribute to improved participation diabetes self-care activities.

The Effects of Language Concordant Care on Patient Satisfaction and Clinical Understanding for Hispanic Pediatric Surgery Patients

Dunlap, Jonathan L. MD; Jaramillo, Joshua D. BA; Koppolu, Raji RN, MS, CPNP; Wright, Robert C. MA; Mendoza, Fernando S. MD, MPH; Bruzoni, Matias MD, FACS Author Information

Transitions from hospital to community care: the role of patient–provider language concordance

BackgroundCultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care.MethodsThis was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit.ResultsOverall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01).ConclusionLanguage-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

Nonemergent Emergency Department Use Among Patients With a Usual Source of Care

Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use. A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use. One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05). Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.