Impact of Physician–Patient Language Concordance on Patient Outcomes and Adherence to Clinical Chest Pain Recommendations

Abstract

Objectives The objective was to evaluate if there is an association between patient–physician language concordance and adverse patient outcomes or physician adherence to clinical recommendations for emergency department (ED) patients with chest pain. Methods We conducted a retrospective observational study of adult ED chest pain encounters with a troponin order from May 2016 to September 2017 across 15 community EDs. Outcomes were 30‐day acute myocardial infarction or all‐cause mortality, hospital admission/observation, or noninvasive cardiac testing. To assess patient outcomes, we used the overall cohort. To assess adherence to clinical recommendations, we used a subgroup of patients with a low‐risk HEART score. A mixed‐effects logistic regression model was used to compare the odds of the outcomes between language concordant and discordant patient–physician pairs, controlling for patient characteristics. Results Overall, 52,014 ED encounters were included (10,791 low‐risk HEART encounters). Of those 6,452 (12.4%) encounters were language discordant and 1.7% in each group had an adverse outcome. Adjusted models demonstrated no increased risk for language discordant ED encounters when comparing adverse outcomes (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.6 to 1.5) for all patients or recommended care (OR = 1.02, 95% CI = 0.87 to 1.2) for low‐risk patients. Conclusions No associations were found between patient–physician language concordance and outcomes or physician adherence to clinical recommendations for ED patients with chest pain. Accessible and effective interpretation services, combined with a decision support tool with standard clinical recommendations, may have contributed to equitable care.

Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada

“…We are aware of 2 studies conducted in the acute care setting, with 1 showing that Francophones residing in Ontario were less likely to experience harm when they were treated in hospitals that were required by law to provide services French. 20,21 We sought to compare the risk of adverse, hospital-related outcomes among frail patients living in Ontario, Canada, after stratifying by patient language and patient-physician language concordance or discordance. We hypothesized that patients receiving language-concordant care would have better outcomes than those receiving language-discordant care.…”

Outcome Disparities and Resource Utilization Among Limited English Proficient Patients After Tonsillectomy

“…15-17 Other publications evaluating language discordance in internal medicine and vascular surgery have cited well-developed interpreter infrastructures as rationale for improved health outcomes. 18,19 Incorporating translated written discharge instructions has also been previously shown to improve short-term comprehension and overall satisfaction amongst LEP patients. 20 Given our findings and the previously reported outcomes, we conclude that it is imperative that all health care practitioners continue to act in patients’ best interests and offer interpreter services or translated discharge instructions in order to mitigate potential complications.…”

Concordance linguistique patient–médecin et paramètres de qualité et de sécurité des soins chez les bénéficiaires de soins à domicile fragiles admis à l’hôpital en Ontario, au Canada

“…La plupart des études sur la concordance linguistique se sont limitées au contexte des soins primaires. Nous connaissons 2 études réalisées dans un contexte de soins aigus, l'une montrant que les francophones de l'Ontario étaient moins susceptibles de subir des préjudices lorsqu'ils étaient traités dans des hôpitaux que la loi obligeait à fournir des services en français 20,21 .…”