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

Seale, Emily; Reaume, Michael; Batista, Ricardo; Eddeen, Anan Bader; Roberts, Rhiannon; Rhodes, Emily; McIsaac, Daniel I.; Kendall, Claire; Sood, Manish M.; Prud’homme, Denis; Tanuseputro, Peter

doi:10.1503/cmaj.212155

Cited by 37 publications

(25 citation statements)

References 46 publications

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“…Our results revealed four pro les, one with easy access in almost all access and continuity components and three pro les with access and/or continuity di culties. Along with other studies, our results show inequitable access and continuity related to multiple and interacting social characteristics, such as poverty, isolation, age and discrimination [10,11,12,13,16]. This study adds to the literature by clarifying how speci c individual social characteristics are associated with an increased risk of experiencing particular access and/or continuity di culties.…”

Section: Discussionsupporting

confidence: 78%

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A taxonomy of patient experiences of access and continuity at team-based primary healthcare clinics

Deville-Stoetzel,

Gaboury,

Berbiche

et al. 2023

Preprint

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Background Access to primary healthcare services is a core lever for reducing health inequalities. Population groups living with certain individual social characteristics are disproportionately more likely to experience barriers accessing care. This study identified profiles of access and continuity experiences of patients registered at team-based primary healthcare clinics and explored the associations of these profiles with individual and organizational characteristics. Methods A cross-sectional e-survey was conducted between September 2022 and April 2023. All registered adult patients with an email address at 104 team-based primary healthcare clinics in Quebec were invited to participate. Latent class analysis was used to identify patient profiles based on nine components of access to care and continuity experiences. Multinomial logistic regression models were fit to analyze each profile’s association with ten characteristics related to individual sociodemographics and two related to clinic area and size. Results Based on 87,155 patient experiences, four profiles were identified. "Easy access and continuity" (42% of respondents) was characterized by ease in almost all access and continuity components. Three profiles were characterized by diverging access and/or continuity difficulties. "Challenging booking" (32%) was characterized by patients having to try several times to obtain an appointment at their clinic. "Challenging continuity" (9%) was characterized by patients having to repeat information that should have been in their file. "Access and continuity barriers" (16%) was characterized by difficulties with all access and continuity components. Female gender and poor perceived health significantly increased the risk of belonging to the three profiles associated with difficulties by 1.5. Being a recently arrived immigrant (p = 0.036), having less than a high school education (p = 0.002) and being registered at a large clinic (p < 0.001) were associated with experiencing booking difficulties. Having at least one chronic condition (p = 0.004) or poor perceived mental health (p = 0.048) were associated with experiencing continuity difficulties. Conclusions These results highlight individual social characteristics associated with increased risk of experiencing particular access and/or continuity difficulties. Personalized strategies are recommended, such as facilitating appointment booking for recently arrived immigrants and patients with low education, integrating interprofessional collaboration practices for patients with chronic conditions and improving care coordination and communication for patients with mental health needs.

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Section: Discussionsupporting

confidence: 78%

“…Inequitable healthcare occurs when access varies by social characteristics rather than need [10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

A taxonomy of patient experiences of access and continuity at team-based primary healthcare clinics

Deville-Stoetzel,

Gaboury,

Berbiche

et al. 2023

Preprint

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“…An intersectionality health equity lens will be used to guide our analysis. Identifying the complexities inherent in providing language and/or culturally discordant palliative and/or EoL care is an important next step in understanding the trends we are seeing in linguistic discordance research using health administrative data in other settings (John-Baptiste et al, 2004; Reaume et al, 2022; Seale et al, 2022). This work will inform clinical practice guidelines for palliative/EoL care for linguistic and cultural minority patients.…”

Section: Methodsmentioning

confidence: 99%

“…Data will be collected through qualitative interviews of primary care physicians who have experienced language and/or cultural discordance when providing palliative or EoL care to adult patients in Ontario. We will build upon a previous population-based study from XX on language concordance leading to more positive in-hospital outcomes among frail home care patients in Ontario, Canada (Seale et al, 2022). Extending the topic with qualitative interviews from the physician perspective will provide more detailed insight into the complexities of negative health outcomes due to language and cultural discordance, allowing an in-depth analysis of the social contexts of those who experience challenges with providing optimal palliative/EOL care.…”

Section: Methodsmentioning

confidence: 99%

“…A recent population-based study in Ontario, Canada showed that frail home-care patients receiving language discordant care faced significantly higher rates of in-hospital deaths, longer hospital stays, and more adverse outcomes (Seale et al, 2022). However, there is limited research on the complexities of language discordant care in relation to access, quality, and delivery of palliative/EoL care, particularly when comparing different primary care funding models and geographic regions.…”

Section: Introductionmentioning

confidence: 99%

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Exploring Primary Care Physicians’ Experiences of Language and Cultural Discordant Care for Linguistic Minority Patients at the End-of-Life: A Study Protocol

Lee,

Gibb,

Karunananthan

et al. 2023

International Journal of Qualitative Methods

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Health disparities exist across different linguistic groups. Language barriers in primary care can negatively affect access to healthcare services and the quality and safety of care at the end-of-life. This study will take a novel, in-depth look at the experience of language- and/or cultural-discordant care for adults from linguistic minority groups through the eyes of primary care physicians providing palliative and/or end-of-life care. Language and cultural discordance means that the physician and patient do not speak the same language or are not from the same cultural background. Qualitative data from primary care physicians ( n = 12–24) providing language-discordant end-of-life care to Francophone and/or Allophone older adults across different care models and diverse geographies in Ontario will be collected through semi-structured interviews. Reflexive thematic analysis will be used to report themes within the data and consider the influence of the social locations of the researcher and research participants, geographic considerations impacting service provision, and barriers imposed by differing primary care funding structures on the provision of palliative and end-of-life care for linguistic and cultural minority groups in Ontario. Findings from this study will identify the interconnections among language and cultural discordance, care model, geographic region, and physician perceptions of their combined effects on access to, and quality of, palliative and end-of-life care. This evidence will be key to informing clinical practice guidelines and mobilizing change to improve primary care access and quality for adults at the end-of-life from linguistic and cultural minority populations across Ontario.

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Language Preference, Surgical Wait Time, and Outcomes Among Older Adults With Hip Fracture

Reppas-Rindlisbacher,

Boblitz,

Podolsky

et al. 2024

JAMA Netw Open

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ImportancePatients with a non–English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care.ObjectiveTo investigate the association of non–English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair.Design, Setting, and ParticipantsThis population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022. Propensity-based overlap weighting accounting for baseline patient characteristics was used to compare primary and secondary outcomes.ExposureNon–English language preference.Main Outcomes and MeasuresThe primary outcome was surgical delay beyond 24 hours. Secondary outcomes included time to surgery, surgical delay beyond 48 hours, postoperative medical complications, length of stay, discharge destination, 30-day mortality, and 30-day hospital readmission.ResultsAmong 35 238 patients who underwent hip fracture surgery, 28 815 individuals (81.8%) were English speakers (mean [SD] age, 84.4 [8.0] years; 19 965 female [69.3%]) and 6423 individuals (18.2%) were non-English speakers (mean [SD] age, 85.5 [7.0] years; 4556 female [70.9%]). The median (IQR) wait time for surgery was similar for English (24 [16-41] hours) and non-English (25 [16-42] hours) speakers. There was no significant difference in surgical delay beyond 24 hours between English-speaking and non–English-speaking patients (3321 patients [51.7%] vs 14 499 patients [50.3%]; adjusted relative risk [aRR], 1.00; 95% CI, 0.98-1.03). Compared with English speakers, patients with a non–English language preference had increased risk of delirium (4207 patients [14.6%] vs 1209 patients [18.8%]; aRR, 1.10; 95% CI, 1.03-1.17), myocardial infarction (150 patients [0.5%] vs 43 patients [0.7%]; aRR, 1.52; 95% CI, 1.04-2.22), longer length of stay (median [IQR], 10 [6-17] vs 11 [7-20] days; aRR per 1-day increase, 1.11; 95% CI, 1.06-1.15), and more frequent discharge to a nursing home (1814 of 26 673 patients surviving to discharge [6.8%] vs 413 of 5903 patients surviving to discharge [7.0%]; aRR, 1.13; 95% CI, 1.01-1.27).Conclusions and RelevanceIn this study of older adults with hip fracture, non–English language preference was associated with increased risk of delirium, myocardial infarction, longer length of stay, and discharge to a nursing home. These findings suggest inequities in hip fracture care for patients with a non–English language preference.

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

Cited by 37 publications

References 46 publications

A taxonomy of patient experiences of access and continuity at team-based primary healthcare clinics

A taxonomy of patient experiences of access and continuity at team-based primary healthcare clinics

Exploring Primary Care Physicians’ Experiences of Language and Cultural Discordant Care for Linguistic Minority Patients at the End-of-Life: A Study Protocol

Language Preference, Surgical Wait Time, and Outcomes Among Older Adults With Hip Fracture

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