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

Abstract

Background: When patients and physicians speak the same language, it may improve the quality and safety of care delivered. We sought to determine whether patient-physician language concordance is associated with in-hospital and postdischarge outcomes among home care recipients who were admitted to hospital.

Methods: We conducted a population-based study of a retrospective cohort of 189 690 home care recipients who were admitted to hospital in Ontario, Canada, between 2010 and 2018. We defined patient language (obtained from home care assessments) as English (Anglophone), French (Francophone) or other (allophone). We obtained physician language from the College of Physicians and Surgeons of Ontario. We defined hospital admissions as language concordant when patients received more than 50% of their care from physicians who spoke the patients' primary language. We identified in-hospital (adverse events, length of stay, death) and post-discharge outcomes (emergency department visits, readmissions, death within 30 days of discharge). We used regression analyses to estimate the adjusted rate of mean and the adjusted odds ratio (OR) of each outcome, stratified by patient language, to assess the impact of language-concordant care within each linguistic group.

Results: Allophone patients who received language-concordant care had lower risk of adverse events (adjusted OR 0.25, 95% confidence interval [CI] 0.15-0.43) and in-hospital death (adjusted OR 0.44, 95% CI 0.29-0.66), as well as shorter stays in hospital (adjusted rate of mean 0.74, 95% CI 0.66-0.83) than allophone patients who received language-discordant care. Results were similar for Francophone patients, although the magnitude of the effect was smaller than for allophone patients. Language concordance or discordance of the hospital admission was not associated with significant differences in postdischarge outcomes.

Interpretation: Patients who received most of their care from physicians who spoke the patients' primary language had better in-hospital outcomes, suggesting that disparities across linguistic groups could be mitigated by providing patients with language-concordant care.

Figure 1:

Study flow diagram. Note: RAI-HC = Resident Assessment Instrument–Home Care, OHIP = Ontario Health Insurance Plan.

Figure 2:

Adjusted in-hospital outcomes for Francophone and allophone recipients of home care. Language-discordant care is the reference in all analyses. Values to the left of the line of null effect denote lower risk of harm (i.e., record of 1 or more adverse events during hospital admission), shorter stays in hospital and lower risk of death among patients receiving language-concordant care; values to the right of the line of null effect denote higher risk of harm, longer stays in hospital and higher risk of death among patients receiving language-concordant care. Effect sizes adjusted for age at admission, sex, marital status, education, income quintile, geographic region, urban or rural residence, immigration status, Charlson Comorbidity Index, diagnostic risk score, activities of daily living (ADL) scale, instrumental ADL scale, cognitive performance scale and changes in health, end-stage disease, signs and symptoms (CHESS) score. Note: CI = confidence interval, OR = odds ratio.

Figure 3:

Adjusted postdischarge (within 30 days of discharge) outcomes for Francophone and allophone recipients of home care. Language-discordant care is the reference in all analyses. Values to the left of the line of null effect denote lower risk of emergency department visits, hospital admissions and death among patients receiving language-concordant care; values to the right of the line of null effect denote higher risk of emergency department visits, hospital admissions and death among patients receiving language-concordant care. Effect sizes adjusted for age at admission, sex, marital status, education, income quintile, geographic region, urban or rural residence, immigration status, Charlson Comorbidity Index, diagnostic risk score, activities of daily living (ADL) scale, instrumental ADL scale, cognitive performance scale and changes in health, end-stage disease, signs and symptoms (CHESS) score. Note: CI = confidence interval, OR = odds ratio.